All health professionals say they are supportive of breastfeeding. But many are supportive only when
breastfeeding is going well, and some, not even then. As soon as breastfeeding, or anything in the life of the new
mother is not perfect, too many advise weaning or supplementation. The following is a partial list of clues that help
you judge whether the health professional is supportive of breastfeeding, at least supportive enough so that if there is
trouble, s/he will make efforts to help you continue breastfeeding.
How to know a health professional is not supportive:
1. S/he gives you formula samples or formula company literature when you are pregnant, or after you have
had the baby. These samples and literature are inducements to use the product, and their distribution is called
marketing. There is no evidence that any particular formula is better or worse than any other for the normal baby.
The literature, CD’s or videos accompanying samples are a means of subtly (and not so subtly) undermining
breastfeeding and glorifying formula. If you do not believe this, ask yourself why the formula companies are using
cutthroat tactics to make sure that your doctor or hospital gives out their literature and samples and not other
companies’? Should you not also wonder why the health professional is not marketing breastfeeding?
2. S/he tells you that breastfeeding and bottle feeding are essentially the same. Most bottle-fed babies grow up
healthy and secure and not all breastfed babies grow up healthy and secure. But this does not mean that breastfeeding
and bottle feeding are essentially the same. Infant formula is a rough copy of what we knew several years ago about
breastmilk which is in itself only a rough approximation of something we are only beginning to get an inkling of and
are constantly being surprised by. For example, we have known for many years that DHA and ARA were important to
the baby’s brain development, but it took years to get it into formulas. But it doesn’t follow that the addition of these
to formulas is doing what they are supposed to, as their absorption from formula is different from breastmilk. The
many differences have important health consequences. Many elements in breastmilk are not found in artificial baby
milk (formula) even though we have known of their importance to the baby for several years—for example, antibodies
and cells for protection of the baby against infection, growth factors that help the immune system, the brain and other
organs to mature. And breastfeeding is not the same as bottle feeding, it is a whole different relationship. If you have
been unable to breastfeed, that is unfortunate (though most times the problems could have been avoided), but to imply
it is of no importance is patronizing and just plain wrong. A baby does not have to be breastfed to grow up happy,
healthy and secure, but it does help.
3. S/he tells you that formula x is best. This usually means that s/he is listening too much to a particular formula
representative. It may mean that her/his children tolerated this particular formula better than other formulas. It
means that s/he has unsubstantiated prejudices.
4. S/he tells you that it is not necessary to feed the baby immediately after the birth since you are (will be)
tired and the baby is often not interested anyhow. It isn’t necessary, but it is often very helpful (See handouts #1
Breastfeeding—Starting Out Right and #1b The Importance of Skin to Skin Contact). Babies can nurse while the mother is
lying down or sleeping, though most mothers do not want to sleep at a moment such as this. Babies do not always
show an interest in feeding immediately, but this is not a reason to prevent them from having the opportunity. Many
babies latch on in the hour or two after delivery, and this is the time that is most conducive to getting started well, but
they can’t do it if they are separated from their mothers. If you are getting the impression that the baby’s getting
weighed, eye drops and vitamin K injection have priority over establishing breastfeeding, you might wonder about
someone’s commitment to breastfeeding.
5. S/he tells you that there is no such thing as nipple confusion and you should start giving bottles early to
your baby to make sure that the baby accepts a bottle nipple. Why do you have to start giving bottles early if
there is no such thing as nipple confusion? Arguing that there is no evidence for the existence of nipple confusion is
putting the cart before the horse. It is the artificial nipple, which no mammal until man had ever used, and even man,
not commonly before the end of the nineteenth century, which needs to be shown to be harmless. But the artificial
nipple has not been proved harmless to breastfeeding. The health professional who assumes the artificial nipple is
harmless is looking at the world as if bottle feeding, not breastfeeding, were the normal physiologic method of infant
feeding. By the way, just because not all, or perhaps even not most, babies who get artificial nipples have trouble with
breastfeeding, it does not follow that the early use of these things cannot cause problems for some babies. It is often a
combination of factors, one of which could be the using of an artificial nipple, which add up to trouble.
6. S/he tells you that you must stop breastfeeding because you or your baby is sick, or because you will be
taking medicine or you will have a medical test done. There are occasional, rare, situations when breastfeeding
cannot continue, but often health professionals only assume that the mother cannot continue and very often they are
wrong. The health professional who is supportive of breastfeeding will make efforts to find out how to avoid
interruption of breastfeeding (the information in white pages of the blue Compendium of Pharmaceutical Specialties
and the PDR are not a good references—every drug is contraindicated according to them as the drug companies are
more interested in their liability than in the interests of mothers and babies). When a mother must take medicine, the
health professional will try to use medication that does not require the mother to stop breastfeeding. (In fact, very few
medications require the mother to stop breastfeeding). It is extremely uncommon for there to be only one medication
that can be used for a particular problem. If the first choice of the health professional is a medication that requires you
to stop breastfeeding, you have a right to be concerned that s/he has not really thought about the importance of
breastfeeding.
7. S/he is surprised to learn that your six month old is still breastfeeding. Many health professionals believe that
babies should be continued on artificial baby milk for at least nine months and even 12 months (and now that the
formula companies sell formulas for up to 18 months and even three years, soon some health professionals will be
urging mothers to use formula for three years), but at the same time seem to believe that breastmilk and breastfeeding
are unnecessary and even harmful if continued longer than six months. Why is the imitation better than the original?
Shouldn’t you wonder what this line of reasoning implies? In most of the world, breastfeeding to two or three years of
age is common and normal, though, thanks to good marketing of formula, less and less common.
8. S/he tells you that breastmilk has no nutritional value after the baby is 6 months or older. Even if it were
true, there is still value in breastfeeding. Breastfeeding is a unique interaction between two people in love even without
the milk. But it is not true. Breastmilk is still milk, with fat, protein, calories, vitamins and the rest, and the antibodies
and other elements that protect the baby against infections are still there, some in greater quantities than when the baby
was younger. Anyone who tells you this doesn’t know the first thing about breastfeeding.
9. S/he tells you that you must never allow your baby to fall asleep at the breast. Why not? It is fine if a baby
can also fall asleep without nursing, but one of the advantages of breastfeeding is that you have a handy way of putting
your tired baby to sleep. Mothers around the world since the beginning of mammalian time have done just that. One
of the great pleasures of parenthood is having a child fall asleep in your arms, feeling the warmth he gives off as sleep
overcomes him. It is one of the pleasures of breastfeeding, both for the mother and probably also for the baby, when
the baby falls asleep at the breast.
10. S/he tells you that you should not stay in hospital to nurse your sick child because it is important you rest
at home. It is important you rest, and the hospital that is supportive of breastfeeding will arrange it so that you can
rest while you stay in the hospital to nurse your baby. Sick babies do not need breastfeeding less than a healthy baby,
they need it more.
11. S/he does not try to get you help if you are having trouble with breastfeeding. Most problems can be
prevented or cured, and most of the time the answer to breastfeeding problems is not giving formula. Unfortunately,
many health professionals, particularly physicians, and even more particularly pediatricians, do not know how to help. But there
is help out there. Insist on getting it. “You don’t have to breastfeed to be a good mother”, is true, but not an answer
to a breastfeeding problem.
Handout #18. How to Know a Health Professional is not Supportive of Breastfeeding. Revised January 2005
Written by Jack Newman, MD, FRCPC. © 2005
This handout may be copied and distributed without further permission,
on the condition that it is not used in any context in which the WHO code on the marketing of
breastmilk substitutes is violated
I highly recommend Dr. Jack Newman’s book, Guide to Breastfeeding (called The Ultimate Breastfeeding Book of Answers in the USA)
www.formomandkeiki.com
