Before I went to medical school, the concept of breastfeeding wasn’t something I thought much about. Growing up I was never around kids being breastfed outside of when I myself was small, and as a male, haven’t really thought much about it. So, imagine to my surprise when I rotated through my two months of Pediatrics and met the male pediatrician that told me he was a Lactation Consultant. A what?! I had never ever heard the term.

Fast forward to now, I’ve taken multiple lectures/seminars on Breastfeeding in general and spent time talking to Lactation Consultants and Occupational/Speech Therapists on the pitfalls, difficulties and successes with Breastfeeding. More importantly, I have sat alone multiple times as the Doctor with a new mother as she is tearful about her struggling to breastfeed. I have heard various cultural and societal beliefs passed down through families from mother to daughter. And I have come across those that are absolutely convinced they will breastfeed when certain situations preclude this or those that are absolutely convinced they will stick to formula and haven’t even considered breastfeeding.

I am trained, adequately in my opinion, on the medical benefits of breastfeeding and the few contraindications. But, the social circles, “mom groups,” and history of breastfeeding and the shifts throughout time from advocating for formula feeding to now breastfeeding has been something I learn more about every day.

Now, to some people, it’s probably still awkward that as a male I’m writing this post, but my job as a caregiver of children is to ensure they grow and more importantly, that the family continues to grow and cultivate their new life – this starts of course, with nutrition for babies, and a discussion of breastfeeding right around the introduction of a new life to our world.

There is so much controversy over breastfeeding, who gets to do it, for how long and increasingly in this day and age, is it ‘appropriate’ to do in public and what do people think about that. But, I think it’s only appropriate to look at the past to understand the future.

Where Did We Come From?

While the history of breastfeeding is not often discussed, some of the earlier discussions of it’s public importance in the US dates back to the 1800s – I don’t mean to be exhaustive about the history but it’s super interesting, so let’s be brief (See the TIME Article Here: Desperate Women, Desperate Doctors and the Surprising History Behind the Breastfeeding Debate¹). Prior to the mid 1800s, if you didn’t have breastmilk for your baby, they would die. If you couldn’t produce milk yourself, there was the option of wet nursing in which another woman would be the one to breastfeed your baby for your; however, although this dates back to ~2000BC, was often a privilege only of the wealthy. Around the time of the Civil War, formula was invented (also referred to as dry nursing)² using formulations of animal milk with various additives (eg: protein or electrolytes) for nutrition. Through the mid to later part of the 19th century, infant pumping³, food preservation and rubber nipples for bottles became more advanced and in the 1920s, non-milk-based products were developed for infants with allergies to cow’s milk (we refer to this in medicine most commonly as Cow Milk Protein Allergy, although the field of allergy vs. inflammatory reactions has now broadened to include many more nuances). With urbanization and industrialization came the development of feeding infants on schedules – until recently, there has been much advocacy to feed infants on strict schedules such as ‘every 3 hours.’ While a large part of this is due to hypoglycemia, or poor sugar/glucose control, it was also easier to have infants on these schedules to allow for parents to work. Well, for those of you that are nursing mothers or work with new babies, you may know that stimulation from feeding is needed to cause hormonal changes to produce more milk – so, sometimes these rigid schedules don’t optimize milk production or fit individual lifestyles.

In 1930 the American Academy of Pediatrics was formed and in 1948 Standards and Recommendations for the Hospital Care of Newborn Infants. This manual was one of the first to describe recommendations for nursing and nutrition of newborns and at the time advocated for nursing when possible. These recommendations were further strengthened and revisited in the AAP policy statement Breastfeeding and the Use of Human Milk in 1997, 2005 and lastly in 2012^4,5,6,7 advocating mainly for Breastfeeding, unless medically otherwise contraindicated.

Where Are We Now?

In the last 20 years in the world of medicine we’ve learned of all of the medical, social, economic and psychological benefits of breastfeeding – the AAP Policy Statement and advice from Pediatricians stems from ample research on the subject. We advocate more and more for ‘ad lib’ or ‘on demand’ or ‘baby-led’ feeding which allows for eating NOT on a rigid schedule and may have positive effects on milk production and caregiver and baby happiness. The pendulum has swung and formula is no longer pushed as a superior means of feeding. In 1991 the World Health Organization and UNICEF launched a campaign for the Baby-Friendly Hospital Initiative which calls for at least 80% of healthcare providers to be educated on the benefits of breastfeeding and a goal for 75% of infants in the hospital to be exclusively breastfed. This has led to healthcare providers even further pushing breastfeeding as the best feeding – as a Resident Phyician I recall multiple times that my attending would get mad if we switched a baby to formula without having a lengthy discussion with mom on WHY she SHOULD breastfeed. However, with all of these strong viewpoints, comes pressure to breastfeed and societal opinions, including staunch comments on how NOT being able to breastfeed consequently may imply failure of a mother to provide for her child. There is a fine fine line between advocacy and pressure, and a slight change in tone or word choice can do everything from creating empowerment to condemnation.

So, why do I write this post? In my short time as a board-certified pediatrician, I have come across hundreds of mothers that want to exclusively breastfeed, want nothing to do with breastfeeding, want to follow certain dietary beliefs (eg: Veganism or “Organic” [whatever that means]) or have no idea what they want to do. I have had those that could care less and those that have broken down in failure because they’ve spent so long reading blogs and posts from mom groups on the internet on how they are FAILURES. I am writing this post for the mothers that sit in my office crying because they aren’t able to breastfeed due to anatomic/production issue of their own. I am writing this for the ones that are just learning about breastfeeding for the first time.

There is NO right answer.

You are NOT a failure if you cannot breastfeed. It is NOT the end of the world. There are so many things that go into Parenting and the fact that you even care about this means that you are a good Parent. There is NO judgment from me. I will continue to advocate for breastfeeding, I will do all I can to educate families and new mothers on how to breastfeed and why it’s a great idea, but I am a strong believer in NOT shaming those that cannot or choose not to. There are myths around breastfeeding and some of these are passed down from family, friends or Dr. Google, but I encourage discussing these concerns and these questions with a healthcare provider and if possible always advocate for the advice and help from Lactation Consultants if available. I share the history of breastfeeding for the purpose of refreshing the fact that it has always been a fluid conversation and that it is a natural part of life.

My job as a Pediatrician is to be an ally and an advocate for families and their children. So at the end of the day while I of course support and discuss the AAP Policy on Breastfeeding, my greater job falls on a holistic support of my patients. Nobody is perfect and there is NO right answer.

References:
1. Rothman, L. “esperate women, desperate doctors and the surprising history behind the breastfeeding debate. Time.” (2018). https://time.com/5353068/breastfeeding-debate-history/
2. Stevens, E. E; Patrick, T. E; Pickler, R (2009). “A History of Infant Feeding”. The Journal of Perinatal Education. 18 (2): 32–39. doi:10.1624/105812409X426314. PMC2684040. PMID20190854.
3. Garber, M. (2013). A Brief History of Breast Pumps. The Atlantic, October, 21. https://www.theatlantic.com/technology/archive/2013/10/a-brief-history-of-breast-pumps/280728/
4. Work Group on Breastfeeding. (1997). Breastfeeding and the use of human milk. Pediatrics, 100(6), 1035-1039. https://pediatrics.aappublications.org/content/100/6/1035?ijkey=6f2a326a8f1909879e1a24ce9c643ff1cef01dd9&keytype2=tf_ipsecsha
5. Gartner, L. M., Morton, J., Lawrence, R. A., Naylor, A. J., O’Hare, D., Schanler, R. J., & Eidelman, A. I. (2005). Breastfeeding and the use of human milk. Pediatrics, 115(2), 496-506. https://europepmc.org/article/med/15687461/reload=0
6. Section on Breastfeeding. (2012). Breastfeeding and the use of human milk. Pediatrics, 129(3), e827-e841. https://pediatrics.aappublications.org/content/129/3/e827.full#content-block
7. AAP Policy on Breastfeeding. https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/Breastfeeding/Pages/AAP-Policy-on-Breastfeeding.aspx
8. Baby-Friendly Hospital Initiative: Revised, Updated and Expanded for Integrated Care. Geneva: World Health Organization; 2009. 1.3, THE GLOBAL CRITERIA FOR THE BFHI. Available from: https://www.ncbi.nlm.nih.gov/books/NBK153487. https://www.ncbi.nlm.nih.gov/books/NBK153487/