Informed is best

Unlike the realities of pregnancy and childbirth, breastfeeding is rarely spoken of and usually dawns on an unsuspecting new mother as a rude awakening once the child is born.

What is expected as a natural transition from pregnancy to motherhood is dotted with overwhelm, surprise and a feeling of inadequacy all rolled into one when presented with a child to nourish. We love to paint a picture of a woman brimming with motherly emotions comfortably nursing her child. That may even be true for some mothers but it definitely is far from reality for most.

It is important to understand that, while breastfeeding is natural, it is a learned skill for both mother and child. Across generations we have gradually lost it as the instinct reinforced as part of a cultural norm. As the practice declined steeply, we lost the village that helped keep the skill alive.

For Pakistani mothers, there is little to no skilled professional support available in the field of Human Lactation, which is helping bring the art of breastfeeding back in other parts of the world. This also makes our situation potent for unnecessary formula pushing. Since breastfeeding works on supply and demand – the more milk is removed from a mother’s body the more milk is produced – any disruption in the frequency of pattern ensures an early cessation of the entire breastfeeding journey. To put it simply, for most mothers this process ends without even being given a fair chance for a lift off.

Human milk not only provides robust immunity and species specific growth pattern a fair chance by giving a human child the nutrition required for the requisite brain development (unlike cow’s milk which most formula is based on), but breastfeeding also acts as a bulwark against many childhood and lifelong ailments. These include but are not limited to respiratory diseases, obesity, organ weaknesses, gut and stomach disorders and vulnerability and renal (kidney) issues.

Despite this incomparability of the two options presented, a lot of times advocacy for breastfeeding is left simply at 'breast is best', never exactly defining exactly how and why this idiom even exists. It is often then met with the 'fed is best' brigade, a movement that originated to ensure no child starved but went on to produce problematic campaigns funded by formula producing companies.

Fed is necessary. If there is no feeding there is eventually and unfortunately no child. I would rather say 'Informed is best', where you know when it is necessary to supplement with formula and when it isn’t. A skilled professional is in fact aware of when formula is actually needed and will suggest it even against the parents' will if there is a possibility of a low breastmilk supply.

Where formula is meant to be a temporary supportive measure in case of breastmilk supply decline while we work on increasing supply, it is instead touted as an allowed alternative which of course is clearly problematic.

Society at large is responsible for supporting breastfeeding through widespread knowledge . It is not just the lactating woman’s responsibility. Medical professionals owe it to their breastfeeding patients to educate themselves further. Apart from that, it is part of their oath to place any prejudices aside when approaching a patient. If they’re allowing a mother the access to her own child for initiation of breastfeeding, which is the normal progression that suffixes the birthing process, that does show that whether or not they understand completely why or how acutely this is necessary. Keeping other mothers deprived of this process in the same facility reeks of either classism or is perhaps owed to the ability of a handful of women to be assertive about their decision, an unfortunately rare instance in our society.

It is not news that women are forever marginalised in our society, their pain discounted and oftentimes ridiculed even at a vulnerable time and place such as the labour room. It is of course no surprise then that if there is subsequent pain and difficulty during breastfeeding it is not just dismissed but doctors are found telling mothers they’re not trying hard enough or questioning their mothering skills altogether. Unfortunately this happens more often than one would imagine.

We need to collectively move forward in longer strides to stand next to women, not just while marching on the streets for their rights but also behind screens in a medical facility where they are at their most vulnerable. Behind doors at home where they writhe in pain but are unable to get support and instead are told that pain is a normal part of initial breastfeeding, which cannot be farther from the anatomical truth or even possibility. Breastfeeding must not hurt at any stage.

Lactation issues need to be addressed and resolved instead of being forever slapped with an unnecessary cessation plan. Instincts can be developed again. Nature never left the building. Breastfeeding Skills’ Education is essential. The best decision is an informed one.

The writer is a certified lactation educator counsellor (UC San Diego), a student of IBCLC and member of LCGB and ILCA. She runs a lactation clinic at Lahore Children’s Centre and Lactnation, the Breastfeeding Support Facebook Group.