La Lache League, haven of extremists

We have been studying women’s health at school the past few weeks. It has been a great way to wrap up the semester for me. I could be writing volumes about it, if I had the time. As Indigo Montoya says, “Let me explain. No, there is no time. Let me sum up.”

I went and talked to our pharm professor about induction for macrosomia (big baby) for a while, and pointed out that our textbook says that ACOG does not recommend it, that ultrasounds are notoriously nonpredictive and outcomes do not improve with induction. She said during class that macrosomia was an indication for induction, and it would be done at 37, 38 weeks. I went to a lecture on a successful maternal mortality and morbidity intervention program at a big hospital, and they had a policy that any induction before 39 weeks needed approval of the director of obstetrics. A read int he New York Times that some insurance companies are refusing to cover inductions before 38 weeks. I sent that article a family member. She got induced (for suspected fetal macrosomia, natch). her induction was unsuccessful, and her delivery was highly complicated. She spent 13 weeks in the hospital. Typical? No. Preventable? Maybe.

My pharm teacher also said how her own 9 pound baby was too big for her hips, but my textbook defined macrosomia at 4,500 or 5,000 g, depending on diabetes (I would have to go back and read that part to get it right…) Anyway, that’s over 9 pounds. She was very cool about it, and said her daughter, with whom she had a failed induction at 37 weeks or so, had multiple infections and lung problems and had to be in NICU a lot.

We have a visiting professor who has been pretty good about a lot of stuff. I made a commitment to only go up and discuss topics if it was evidence based. He did the lecture on external fetal monitoring, and did a good job of presenting the lack of evidence on its superiority to intermittent monitoring, and gave a good list of risks (many) and benefits (few) of internal fetal monitoring.

But, the next day, he steamed through intrapartum care. He went off on a rant about La Leche League. He stated that there benefits and disadvantages to both breastfeeding and formula feeding. He said his wife watched a La Leche League video which listed the benefits of breastfeeding, and then said, “If you have chosen to formula feed, that is OK, too.” His wife was apparently devastated by this comment. He was still angry. “Can you imagine saying that?” Yes, yes I can. He called La Leche League a bunch of extremists.

(By the way, professors in obstetrics are very funny about how they will complain about how everyone tells pregnant women horror stories, which is true, and then will proceed to give their own horror story example and extrapolate that into what they think should be standards of care. I have seen that 3 times in this system alone, at least.)

Now, I can’t vouch for each and every gorup leader or member. I have had someone tell me that one local group leader was discouraging someone from supplementing at all, even when her baby was clearly failing to thrive to the point that its developmental milestones could be affected. There are ways, with supplemental lactation systems and pumps, that mothers can still try to establish a successful breastfeeding relationship and still make sure the baby is getting adequate nutrition. I know some moms cannot breastfeed for a variety of reasons, and no one should ignore very real health issues on the maternal or neonatal side when considering breastfeeding.

Then he said the killer statement that always gets me: “It is a lifestyle decision.”

No dude, no it’s not. It’s a health decision. It’s not a lifestyle decision. I pumped at work for two babies. I know residents who have managed to pump. No one’s lifestyle precludes her from breastfeeding. Are there socioeconomic factors that influence a mother’s success in breastfeeding? Absolutely. Just like there are lifestyle and socioeconomic factors that influence compliance with many health decisions that involve ongoing behavior, like HAART in AIDS treatment, liver dialysis, low glycemic diets for diabetics, etc. That does not make these lifestyle decisions.

Just like any other health decision, there are many issues to consider when discussing breastfeeding with a prospective mother. Any pregnant person who can consider breastfeeding because it is not completely contraindicated for her and the baby (which is rare, but happens, such as in cases of HIV+ moms, certain drug regimens, etc.) should be told a list of the health benefits of breastfeeding for the baby and mother. They are facts. These lists do not exist to make moms who cannot / do not breastfeed feel guilty. Just like lists of the benefits of exercise do not exist to make couch potatoes like me feel guilty. Yes, some people can’t exercise due to health reasons. Some people have little time or opportunity to exercise due to lifestyle and socioeconomic reasons. Does that make the decision to exercise or not a lifestyle decision? Of course not, it is a health decision with many valid options. Does that mean doctors and their teams should not have a nuanced discussion with their patients about the benefits of exercise, with obvious attention to the personal medical history of the individual, as a component of true informed consent and patient education? Just in case someone like me feels guilty that I don’t try harder to make time? Or someone with advanced rheumatoid arthritis or some other condition may not even be able to exercise much if at all?

Healthy People 2010 has tracked the abysmal breastfeeding rates. We don’t need people teaching the practitioners of the future to tell future doctors that breastfeeding is a lifestyle decision and any promotion otherwise is extremism.

Oh, and I am a finalist for the research fellowship. More vibes, please!

9 Comments

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9 responses to “La Lache League, haven of extremists

  1. Assuming that your prof isn’t actually interpreting how LLL advocates for mother-friendly hospital conditions and mother-to-mother education as anti-medical or some kind of coup, then I’d imagine it’s because he sees breast and bottle as equally capable of sustaining an infant. Formula is pretty amazing these days. So I guess it’s an extreme measure to feel strongly about feeding your child your own milk when there’s a readily available, reasonable alternative? Like you’re doing something unnecessary and excessive?

    Maybe he just met someone that he thought was nutty who happened to be in LLL.

    LLL is great for info and support. I wish more new moms knew about it.

    I nursed as I typed this, btw.

  2. turtle

    This was really interesting to read. It’s so frustrating that even if the profs are teaching good stuff but are still woefully biased against something like LLL. I’m not sure why his wife cried after hearing the video say that it’s okay to formula feed…sounds to me like they were trying NOT to load the guilt on. (But sometimes it seems like as mothers we’re willing and ready to feel guilty about anything, if we let ourselves). Anyway, I think you have a good perspective on it- breastfeeding is a health issue. (By the way, calling it a “lifestyle choice” reminds me of when being gay used to be called a lifestyle choice. Probably it still is, sometimes. Drives me batty in a similar way).

  3. turtle

    Just read Jill’s comment, and realized– yes I wrote my comment while nursing too! (it’s the rare comment/blog post that’s written NOT while I’m typing these days)

  4. MomTFH

    Formula is pretty amazing, but breastfeeding does have definite benefits above and beyond formula, and breastfeeding is difficult to accomplish without a lot of dedication, and usually a lot of support.

    There is a reason why increasing breastfeeding rates is a goal of Healthy People 2010. Lots of research supports increasing breastfeeding rates. No evidence based medicine does not support teaching there is no difference between the two decisions.

    Is a mother who can’t / won’t breastfeed doomed? Of course not, and literature or media targeting formula feeding moms should not make them feel guilty or bang them over the head with advantages for breastfeeding. But in a class on prenatal care for pregnant women? It is not an appropriate message.

  5. So here’s the thing. In the US, there is very little legal support for breastfeeding. We don’t have paid maternity leave, we don’t have laws requiring employers to support/allow pumping or breastfeeding. We’re not THERE.

    In light of that, it IS medically responsible to support women who choose to (or have to) use formula. Women who can’t breastfeed (hi!) for whatever reason NEED support, especially in the fragile periods like pregnancy and that whole post partum disaster.

    I think it would be fanfuckingtastic if more babies were breastfed. It’s something I planned to do for my own children, but sometimes things don’t work out, and it’s nice to have a doctor say “Seriously, it’s not poison, it’s just formula. They’ll be fine.”

    If we have the LLL on one side saying “OMG, formula is evil!” and the government on the other side saying “Say, you should breastfeed. Oh. We’re not going to HELP you with that or anything, but you should,” it’s like putting new mothers through a meat grinder.

  6. I really like the tone you struck with this post. The exercise analogy is pretty apt, in my opinion. Of course, when I feel guilty for not exercising it’s on my own behalf, whereas if I feel guilt about a parenting decision it has (obviously) much broader ramifications. I *don’t* want to see women guilted into breastfeeding. There’s enough toxic mother-blame already going around.

    Yet I suppress a grimace every time I see an obviously working-class young mother (lots of poor white teens in my corner of Appalachia) who’s feeding her weeks-old infant from a bottle. Buying formula is likely a stretch, and that baby has enough socioeconomic strikes against her anyway … I try not to judge, but I can’t help thinking that these young mothers need some serious social support and maybe a good nudge to at least give breastfeeding a sincere try.

    (Full disclosure: I breastfed both of my boys exclusively for 5 months, weaned them both around 10 months.)

    As for induction due to suspected macrosomia: My first baby was not macrosomic but had a noggin at the 98+ percentile. I delivered with the help of a vacuum extractor and sustained some pretty bad damage. (He is fine.) For my second, I felt the only reasonable choice was between an elective c-section or induction at 38 weeks (baby #1 was a couple weeks late). We induced, it took so well I didn’t need any Pitocin once labor was established an hour later, and I had only minor tearing, no episiotomy. My ob/gyn wouldn’t have done it if he hadn’t been confident that it would work – I was already partially dilated. Frankly, this decision may have kept me out of diapers. I recognize that others’ experience will vary. We make the best decisions we can with the inadequate information we have, and then we have to hope for a dose of good luck.

    Thanks for the thought-provoking post!

  7. MomTFH

    Thanks for all the replies!

    Of course women who use formula should be medically supported. And in this particular video, according to the physician, the narrator said “Feeding formula is OK, too!”, not that it is evil. Of course La Leche League’s official stance is not that formula is evil.

    I strongly agree that federal policies, private businesses and society should be more supportive of breastfeeding in the United States. And, medical students should be taught that breastfeeding is a health decision (as heavily nuanced as many others) with significant benefits, and that formula is a life saving, nourishing alternative when necessary.

  8. I agree 100% that women who breastfeed should be supported and never harassed.

    Because breastfeeding is physically demanding on women, I believe that there are situations in which a woman could make a rational and defensible decision to not breastfeed.

    However, for the majority of women in America, these situations will not arise, and breastfeeding should be promoted and supported.

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