In “Breast or Bottle – The Illusion of Choice,” Dr. Amy J. Kennedy chronicles the difficulties she faced when breastfeeding her baby:
"The question was always posed to me in a hurried manner, an item on a long checklist that the obstetrician, labor and delivery nurse, and pediatrician all needed to get through: “Will you breast or bottle feed?”
As a first-time mother, I was anxious about the uncertainties that lay ahead and uncomfortable with the never-ending strings of questions about my upcoming delivery. As a physician, I was relieved when we got to the breast-feeding question. It was a simple answer, a yes–no question. I confidently answered “breast-feed!” each time I was asked, assured by the science I had learned in medical school and by the American Academy of Pediatrics (AAP) recommendations to exclusively breast-feed for at least 6 months, followed by continued breast-feeding for 2 years or beyond. Who would ever choose otherwise, I wondered. It wasn’t until later that I realized breast-feeding was not the clear decision I thought it would be.
As a new mom, I had no idea what I was getting into."
As a breastfeeding advocate, reading about Dr. Kennedy’s rough ride made me cringe over and over again. Such struggles are why the field of breastfeeding medicine exists: to help mothers avoid such hard times.
One cringeworthy detail: Dr. Kennedy says that she had asked for a lactation consultant immediately, but had to wait two full days (over a weekend) to see one. Unfortunately, that isn’t very unusual in the American hospital experience. Hospitals should pay that little bit extra to have mothers better served. It is perplexing that Dr. Kennedy is not channeling her righteous indignation to address this situation.
Dr. Kennedy then complains about nipple guards that didn’t fit — “that fall off in a millisecond.” Maybe she needed a different size. There are several options. That is followed by the complaint that the next lactation consultant didn’t think they were necessary when she was evaluated several days later. Maybe the situation was different. That is likely when the breasts are undergoing dramatic changes during the first few weeks. But torching lactation consultants is not helpful. And yes, it makes me cringe.
When told her baby was underweight by the pediatrician after she was discharged from the hospital, Dr. Kennedy describes the doctor’s advice to triple-feed as “a cycle of breast-feeding, pumping, and formula feeding that takes at least 60 minutes to complete, repeated every 3 hours.” This is one method to help increase milk supply. Personally, I am not a fan because it is rather arduous and there are other ways to achieve the same goal more humanely. Besides there isn’t scientific data showing it is better than other simpler approaches. Yet she persisted, in the manner of Captain Ahab, to achieve her goal. The cost was her mental and emotional health. Big time cringe.
Then, Dr. Kennedy tells how she spent hours scrolling through mommy blogs. Cringe! One of the more common causes of modern-day insomnia is scrolling for hours. It is an example of electronics making our life harder, not easier. It is sad that she didn’t have a real live personal connection to help her get through this tough time. Phones don’t tell us that we need to just go to sleep for more than 2 hours, but a true friend would. Her chronicle emphasizes how bad sleep deprivation can be. It is annoying to me that it wasn’t addressed by the pediatrician. Cringe!
The author reports how she was told to keep doing what she was doing despite not doing well. Such bad advice! Her struggle with mental health should also have been addressed. Six months after the delivery of her baby, she found “the first sympathetic clinician I had spoken to about my struggles.” Cringe! That’s too long to wait for support, in my opinion.
Finally, Dr. Kennedy calls upon the American Academy of Pediatrics to modify their breastfeeding statements based upon the rough ride she and other mothers have endured. Cringe! The AAP’s policy statement is based on data, not feelings. The approach of “Well, I couldn’t do it, so you need to change the criteria” is based on emotions, not science.
The troubles this mother faced is one of the main reasons for the existence of the Academy of Breastfeeding Medicine. American doctors, in general, have not been trained to adequately support mothers with breastfeeding problems. We don’t live in a breastfeeding culture. Over the years, more mothers in the U.S. are breastfeeding for longer periods of time, but it can certainly be difficult to swim against the tide. I think Dr. Kennedy would have done better with support from people (family or friends) who understood what she was dealing with.
And regarding the title of the piece, there really is no illusion of choice. The choice to breastfeed or not is hers to make. Support is key.
Breastfeeding failure is real and has always been a thing. If it happens, it doesn’t make that mother a failure… or a bad person.
Here’s hoping Dr. Kennedy can learn from her prior difficulties to have a better experience the next time around. And maybe even help other mothers who find themselves in similar situations.
Dr. Brian Donnelly has a special interest in breastfeeding. He was the initial recipient of the Allegheny County Health Department’s Breastfeeding Advocacy Award. He is a Fellow of the Academy of Breastfeeding Medicine and can perform the frenulotomy procedure for tongue-tied infants who have trouble nursing. Dr. Donnelly sees patients at the AHN Pediatrics Northland office.
This was first published to the "Pediablog" on April 27, 2023.