By Nickey Jafari
My rotation in obstetrics & gynecology (OB/GYN) was full of emotional moments, and the first time I witnessed a mom breastfeed her baby was one of my favorites; in a culture that so overtly sexualizes women’s bodies, it reminded me that breasts had evolved for the purpose of nurturing a new human life. Of course, breastfeeding is not always easy, and the decision to breastfeed is a deeply personal one for a woman. Mothers who are unable or unwilling to breastfeed should never be shamed for it. However, the health benefits for both mom and baby are plentiful. We should seek to strike a balance between educating people on the myriad of reasons to breastfeed, while not making women feel pressured to do so.
The World Health Organization recommends exclusive breastfeeding for at least 6 months and reiterates well-known benefits, such as reduction in gastrointestinal illnesses for baby, increased neonatal immunity to infections, and reduced newborn mortality. For mothers, the WHO states the reduction in risks of both breast and ovarian cancers as other reasons to breastfeed. Some of the contraindications to breastfeeding can be found here, and include galactosemia and untreated, active tuberculosis.
Given all its benefits, breastfeeding is a public health priority. The CDC Breastfeeding Report Card 2016 shows that most mothers do want to breastfeed, but rates of exclusive breastfeeding through 6 months are as low as 22.3% throughout the U.S. Barriers to Breastfeeding in the United States frames the issue of expectations on breastfeeding very well – “even though breastfeeding is often described as “natural,” it is also an art that has to be learned by both the mother and the newborn”. Thus, education on breastfeeding techniques, such as the best way to achieve a proper latch, should be provided to moms. Empathy and encouragement go a long way, too. I remember on my pediatrics rotation, when we would check in on our new babies, a lot of moms would get frustrated if the process was not going smoothly because of this societal expectation that breastfeeding is an easy and innate process from the get-go. I noticed some moms who gave up because they felt like, since it was not going well, they were failing at being a mom, and others who switched to formula soon after because they were worried about their baby getting enough nutrition. Their decision did not come from any selfishness, but genuine concern for what is best for their child, and thus I always get upset, as someone who does enthusiastically promote breastfeeding and its benefits, when I see someone judge a woman who does not; we have no idea what her journey was. A little encouragement from clinicians to new moms that it is also “natural” for it to take some work, that they are doing a great job and should keep trying, that their milk amount will continue to increase after the first few days of colostrum, can make a world of difference.
Overall, there are far too many impediments to breastfeeding to address in a single blog post, but in addition to better education to new moms by their clinicians, they include changing societal norms and expectations, increasing social and family support, and creating work policies that allow women to breastfeed. Grace DeHoff wrote about her journey into motherhood as a medical student and touches on breast feeding time commitments. A great post about experiences pumping as a surgeon mom can be found here. The fact of the matter is that “many women face barriers to breastfeeding; poor breastfeeding environments where women work, live, and obtain health care are among the biggest barriers” (read more here). One critical policy area where the U.S. lags far behind other developed nations is the issue of maternity leave. The Family and Medical Leave Act only allows for up to 12 weeks of unpaid leave. The AWS maternity policy for surgeons in practice can be found here.
We can and should promote breastfeeding while not making women feel less than as mothers if it is not the best choice for them. We should be especially careful about promoting “breast is best” if we are not simultaneously working to create more flexible work policies, change societal expectations for new moms, and provide the tools that can allow women the chance to successfully breastfeed!
Nickey Jafari finished her third year of medical school at the University of Kansas this past spring and is currently pursuing her Master of Public Health at the Johns Hopkins Bloomberg School of Public Health.
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