On Giants' Shoulders

Sunday, May 24, 2009

Product, Process, or Relationship

For the past year and a half I've had my head back into a subject which (while never gone from my memory) had not been at the forefront for many years. I've been studying human lactation in preparation for taking the International Board of Lactation Consultant Examiners test this summer. Becoming a lactation consultant was, I thought for a long time, a dream whose time had come and reluctantly passed. It turned out that the time simply hadn't yet been right to do it. Some people assumed that it was my daughter's pregnancy that sent me scurrying down this path, but, in fact, I started the process before she ever even got engaged. It had to do with picking up something that I was good at, that I really loved (i.e. working with nursing mothers) and beginning to do it again.

It's been an interesting time. I've done a ton of reading, some simply in order to get reactivated as a La Leche League Leader, some towards getting my CLC accreditation last fall, some in preparation for the IBLCE exam, and some simply because I frankly find the topic fascinating. I can quickly bore those who don't find it interesting (a fact which my son and husband will readily attest to) with various arcane facts I've learned. I attended a lactation counselor's class last fall which was interesting, informative, etc. I've been attending, and now leading La Leche League meetings for the first time in 20 years. That is an interesting experience in itself.

What all of this has done, in addition to preparing me for the exam, is raise questions in my mind about breastfeeding in our current culture. When I first encountered a breastfeeding mother when I was in junior high school it was certainly a novel experience. I'd not only never seen a baby breastfeed before, but I didn't know that anyone outside of the jungle even did it anymore. However, my reaction was positive and pretty much instantaneous. I was doing a Girl Scout badge in child care about the same time. One of the things I'd had to do for the badge was demonstrate feeding and bathing a baby using a life sized doll. The feeding part required taking the plastic lid of the bottle and using it to carefully push the nipple through the hole in the screw cap without ever touching the nipple with my fingers. It was the one part of the demonstration that I thoroughly blew. My reaction was, "Well it really doesn't matter to me, because I'm going to breastfeed my babies." Now that may be an example of how to turn failure into success or simply an excuse for being a butter fingers, but, in fact, I never changed my mind. I chose breastfeeding based on what I saw with that one encounter with a mom in my neighborhood. I liked what I saw of the relationship between her and this tiny person (who was in fact her 9th baby).

Through my teens and early twenties I did encounter the rare breastfeeding mom, but most of my friends' babies were on bottles. I was fortunate that the wife of the pastor who married my husband and me was a breastfeeding mom. Her one piece of pre-wedding advice was, "When you have a baby get in touch with La Leche League." I'd never even heard of the organization, but I filed that piece of wisdom away in my brain. Fortunately, the local La Leche League leader happened to be a member of the church my husband and I attended after we got married, so getting in touch with La Leche League didn't involve calling up some strange person. It's a good thing, because Glenna did stop by after the baby was born, and I did need her help. I didn't actually start going to La Leche League meetings until after the baby was born (a mistake in retrospect), but once I did, I became fascinated not so much by the process of breastfeeding as by the relationships.

I became a La Leche League Leader when my son was about a year and a half old. What I knew at that point was a lot about how to help mothers with typical difficulties, how to support mothers in their breastfeeding experience, how convenient breastfeeding was, and what a wonderful relationship breastfeeding produced not only with your baby, but with your husband and with these other breastfeeding moms. To this day there is nothing more relaxing to me than sitting in a room with a bunch of moms who are nursing their babies (even when my own "baby" is 27 and about to become a mother herself). It is such a different environment from other social settings, it often feels like someone turned off the clock, although we do have to sort of keep an eye on it so that we end somewhat nearly on time.

What I knew less well at that point was about human milk as product. I certainly read "The Specificity of Human Milk," and I read the increasing studies that were coming out at that point postulating the importance of human milk in Type 1 diabetes prevention, the prevention of severe allergies, and even SIDS prevention. However, much of what is now known about the importance of human milk had yet to be discovered. We did know that it was vital for third world women to nurse their babies, but thought that was largely due to water contamination and lack of money for formula. We didn't know the extent to which breastfeeding could make a difference in infant morbidity and mortality even in the first world. We weren't focused on product, we were focused on the mother baby dyad and supporting that relationship.

Last fall as I went through the CLC class I learned a tremendous amount about process. It meant unlearning a few things that I used to know and learning new things about latch, scheduling, skin to skin, self attachment, and ways of dealing with complex problems. It was a course well worth taking, yet at the end of the week I came away wondering if it weren't so process focused that the participants lost sight of the fact that what we were talking about was an important relationship. I wrote to the leader who was in charge of my LLL reactivation about the class and about my concerns that we were so overmedicalizing the process instead of focusing on the mother and the baby, and encouraging the mother to become the expert on her own baby. The class made me really wonder what I would want to do with the LC certification once I got it, because I couldn't really see myself being as clinical as some of what was being suggested. While the clinical information is important, mothers and babies are not simply pieces to a machine to be assembled correctly and the overly clinical approach can convey this impression.

Recently, I spoke with a someone whose daughter-in-law "failed" at breastfeeding, but succeeded at pumping. With her second baby she chose to not feed the baby at the breast at all, but to simply pump. This is an example of focus on product. We have convinced mothers that human milk is incredibly valuable, and it is. However, what they seem to be learning, is that they can be producers of human milk as well as producers in the workplace without having to take the time to establish that delicate dynamic between mother and nursling. In short the product has, in a bizarre way, replaced the relationship. It isn't that these are bad mothers, it's that a mother who never feeds her baby at the breast is not having the same relationship with that baby as the one who does. The mother who only pumps is actually missing out on something, and she doesn't even know it. Some mothers may pump in order to maintain the nursing relationship. They pump to provide bottles for a couple of feedings a day so that they can have the nursing relationship the rest of the time. That's a very different thing from simply seeing human milk as a product to be supplied. We live in a world that is dominated by production of product, how sad that one of the most fundamental relationships a person can have would be altered to become a matter of providing a product.

I read an article a few months back about mothers being turned into their own wet nurses. It talked about ads showing the corporate mom in her Prada shoes tripping gaily off to the office breast pump in hand. My daughter actually worked for someone who did just that. The baby was mothered most of the time by a nanny while the mother continued to work at a very high paid job. She clearly loved her child and wanted her to have the best in life, but her relationship with that child was to a large extent secondary to her career and the very affluent lifestyle she had carved out for herself. She was making an enormous effort to continue to provide breast milk for her child, but taking a year off for mothering wasn't something she was willing to consider.

In our efforts to encourage parents to be to consider the case for breastfeeding, or to encourage employers to consider the business case for breastfeeding it is easy to focus on product. I know that when I talked with my son-in-law about breastfeeding I focused on the evidenced based studies, the value of human milk, and the cost of formula. Those are great selling points to males. As we attempt to turn hospitals into baby friendly places instead of advertising arms of the pharmaceutical industry, it is tempting to focus on product. We can look at human milk direct from mom as simply the top of the hierarchy of feeding choices with number two being the mother's pumped milk, number three human donor milk, and the pharmaceutical industry's artificial baby milk coming in dead last. However, if all we focus on is the product we are missing a vital part of the picture.

Our society has been focused for a long time on what people produce. I once read a piece that talked about breastfeeding mothers not contributing to the gross national product in the way that formula feeding mothers do. Of course the flip side of that is that breastfeeding mothers also don't have the impact on the environment that formula feeding mothers do. There is none of the waste associated with formula containers, or formula manufacture. However, I wonder whether part of the reason that breastfeeding has been so devalued, even as we recognize the value of the milk, is that we have fallen into the trap of only valuing those activities we can put a price tag on.

We could create situations where mothers don't have to choose between product and relationship. We could create workplaces where infants are welcome, we could create systems where maternity leaves were long, we could create more jobs where mothers could actually work from home. Our world, our country, does not have to be baby unfriendly. It is possible for babies to be present at church, at funerals, at meetings, at work places if we choose to make that happen. It is also possible for us to continue to have raised eyebrows when a mother brings her baby into a meeting or discretely nurses her baby in church. If we don't value the relationship we will say things like: "why doesn't she get a sitter," or "why doesn't she use a bottle."

I honestly believe that it is a huge mistake to think that we are merely substituting the breast for the bottle (even if once upon a time a medically oriented community encouraged us to do the reverse) when we breastfeed our babies. Nursing your baby, while it certainly is about feeding, is not just about feeding. Nursing your baby is simply the easiest way of mothering your baby. It doesn't always feel like that in the first weeks. There is a learning curve for both mother and baby. Relationships are like that. There are intangibles here that no one but another mother who has breastfed her baby can understand. It's those intangibles that don't get measured in our "evidenced based" studies. In the long run, though, it's those intangibles that keep mothers going when the society around them is unsupportive, when there is little encouragement from friends and family.

This spring I went to a conference where one of the speakers spoke about the way that the profession of lactation consultancy had become too technically oriented. She, like me, was concerned that we were forgetting why most of us had nursed our babies in the first place. While we have convinced mothers of the value of human milk, the profession was falling into the same trap of having 1000 techniques all of which mothers "needed" to know in order to nurse their babies. The mothers were getting overwhelmed in the process. She suggested that we go back to the description in the earliest Womanly Art of Breastfeeding and rethink the approach. It isn't that those 1000 tricks don't have their place. It's great to know that there are techniques to help mothers who truly run into unusual problems. However, we shouldn't be looking for zebras every time we see a field of horses. Most mothers will do far better to simply focus on their baby, not on the techniques. Most lactation consultants and counselors will do far better to encourage mothers to look at their own baby.

It isn't the product (while the product is of inestimable value), it isn't about the process (although knowing something of the process may be helpful, your body does remarkable things without you knowing how it does it), it's about a relationship with a tiny new person. The job of a lactation consultant, lactation counselor, La Leche League volunteer is to gently encourage you as you get to know that tiny new person. We should be attempting to support mothers in this relationship, not get so caught up in how many ounces the baby has transferred, how many suck/ swallows they've had in a minute. Some babies will always feed quickly, other babies are gourmets who savor their meals. When we become too fixated on process we attempt to hurry the gourmets along in the name of efficiency. We start saying things like "feeds shouldn't take more than 20 minutes." Mothers start listening to "experts" who tell us things like: "you shouldn't need to do night feeds after 3 months." We need to encourage mothers to listen to their babies, to focus on the delicate dance that they are doing with this little person and not be pulled away from that dance too early.

So what will I do with the certification if I manage to pass the test? I'm still not completely sure. What I know is that I love being part of a community which supports moms in that delicate dance. I want to be someone who helps mothers be all that they can be. I've known just enough mothers in the past who needed just one phone call's worth of my time in order to go on to successfully nurse their babies. I've been thanked enough times for my support after toddlers have finally weaned, to know that it's a job that's well worth doing. I want to be part of a community which helps the larger community begin to understand he delicate dance and to value it as well. It may not contribute to the gross national product, but it just may change the face of our society if we begin to consider people more important than things and value the breastfeeding relationship as well the milk.


At 8:13 AM, Blogger elizabeth said...

I have seriously considered becoming a Lactation consultant too. My last child (as I am quite certain I am in menopause ;-)) would not/could not nurse. I think it was the hospital - the myriad of nurses that forced me to formula feed because he was showing (minor) signs of jaundice, just not latching well...I tried for 3 months at home. I did begin pumping for supply and used a nipple shield (which I find huge and obnoxious in size - medela brand. I recently found a better one, though to late - in Europe.)
Went to a nurse/lac consultant and she was truly unable to help us. I was unable to get ahold of any local LLL members (out of town, not available - left messages and emails.) It was heartbreaking. I had a 6 week learning curve with my first, none at all - with my second ;-) and ended up full time pumping for my last kidlet. I would LOVE to help people understand, as you say - it is NOT about the milk (overall)...I'll stop now - but could definitely go ON and on. :D

I wish you all the success with your future as a consultant. You'll pass - because you're doing it with the right spirit, and all heart!

God Bless - and Bless all those babies and mama's that will experience help/love through your expertise!

At 7:10 AM, Blogger Liz said...

The baby I had difficulty with (similar to what you mentioned) was actually my first. Fortunately, he got one good feed in the hospital (because of one good nurse) before we ended up on a three week roller coaster of nipple shields, daddy insisting on at least one bottle of formula, grandma suggesting bottles of water, etc). My LLL leader arrived on the scene at that point and got me to try to nurse him without the shield and for whatever reason, it worked.

I honestly think there are more babies out there who aren't nursed due to plain mismanagement by hospital personnel than anything else. It's frustrating, even as a LLL leader because we don't get to even see the mom until some maternity nurse or other has already done a lot of damage with her misinformation.

Your baby who wasn't latching on well could have been supplemented by spoon with your milk for the jaundice. They could have gotten someone in to work with the latch early on. They could have put you skin to skin with your baby and seen if he wouldn't self attach once he wasn't screaming with hunger.

The reason that none of those things happened was that they still don't know how to manage nursing difficulties on most maternity wards. The reason they don't care that they don't know is that they continue to believe that while breast is best that formula is just as good.

Good for you to continue to provide your milk despite all of the difficulties. I'm so sorry that the LC you went to was unable to help you. I've been in the position myself in the past of not having enough information to really help a particular mother as much as I would have liked. At the time there were no LC's at all and even the amount of information out there for LLL leaders was not as abundant as it is today. What's really to bad is that there probably are LC's out there who really could have helped you. If your LC had simply contacted someone like Catherine Wattson Genna or Diane Wiessinger she might have found they had information that would have helped her help you.

I'm not so arrogant as to believe that I have all the answers for lactation problems. In fact, I'm not sure that one of my strengths is that I know I don't. Unlike some maternity nurses who believe one size fits all (even one size nipple shield). I know that there is more than one way to deal with a problem and if I don't have one, I need to find out if someone else does.

What those maternity nurses don't know is that a. formula isn't just as good and b. it isn't just about the milk.

If you're really interested in becoming an LC I would encourage you to look into it. A good place to start might be looking into LLL leadership. It's a great way to earn the clinical hours you need to sit the exam. There are other programs out there as well. Check out the lactation programs at Health-E-Learning for example and there is at least one college out there that is now offering even master's level work in lactation.

Someone who's had difficulty with lactation can make an even more dedicated advocate for other mothers.


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