Is the professionalisation of breastfeeding doing harm? It’s a question that’s worrying Professor Lesley Barclay, the director of the Northern Rivers University Department of Rural Health.

Lesley Barclay writes:

This last week, I was travelling Australia as a speaker for the Australian Breastfeeding Association (ABA), sharing experience and research with two international speakers from the US and UNICEF and a local colleague. There were hundreds of dedicated breastfeeding counselors, lactation consultants, midwives and physicians to listen to us in audiences from in Hobart, Melbourne, Canberra and Brisbane.

We were talking about one of our most important public health activities. Breast feeding improves the health of mother and infants well as conveying economic, environmental and social benefits. Infectious diseases are more common in infants not receiving breast milk and chronic disease is more common in adults who were not breast fed. Nearly 300.000 babies are now born  annually in Australia can be protected by breast feeding.

Compared with the US, Australia seems like a breastfeeding paradise: with our free universal services from experienced maternal-child health nurses and midwives and local, health-professionally led mother’s group. Our Breast Feeding help line run by ABA is also unique with thousands of calls answered annually by trained ABA counsellors. Baby Friendly hospitals are becoming more common, and 90% of mothers initiate breastfeeding.

Yet breastfeeding rates decline rapidly and rates of exclusive breastfeeding at around 6 months are hardly higher here than in the US. This is what disturbs me.

My talk was based on a background as a midwife and health services researcher committed to reform in the design and delivery of maternal child health care and rural and remote health.  I drew on research over a number of years from people such as Virginia Schmied from the University of Western Sydney. She led a recent research metasynthesis published in Birth that helped inform my arguments.

Increasing professionalisation of breastfeeding and rigid implementation of rules appears to be undermining breastfeeding mothers.

Taking this further this point seems to be contributing to iatrogenisis and declining rates. I argued that expert-driven models of breast feeding education and support that are becoming more common can weaken a woman’s confidence and prioritize breast milk delivery to babies over the mother-baby relationship.

Rigid implementation of policies and rules about the use of dummies and rooming-in can have a perverse impact on breastfeeding. They can place staff in opposition to a mother’s need for rest or self determination in relation to her baby.

The trend to use a Lactation Consultant to undertake normal breast feeding is costly and diminishes social support and role modeling from peers. It is analogous to employing an obstetrician in normal birth. The costs and morbidity that has resulted from this practice is now is being addressed by a national policy to reduce intervention in childbirth and address our out of control caesarean section rate.

Mothers need to make well informed decisions about their babies. Rather they appear to be at the mercy of hospital policies or staff and poorly designed services. The need to be expert overrides the sustained relationship shown to facilitate breast feeding. Research shows that a hospital postnatal ward can be a terrible place for a healthy mother-baby dyad to begin their breastfeeding relationship. Shortage of staff, sporadic disconnected interactions do not help.

Women and their babies are being ‘treated’ as machines vulnerable to malfunction, creating iatrogenic illness. Early discharge, with home follow-up visits from a skilled midwife or mother-baby nurse, could provide a far more natural, relaxed environment for learning to breastfeed. Continuity of care models of birth, still received by the minority of women, are ideal

When breastfeeding becomes a professional event, fraught with instructions and prohibitions, we as professionals assert our expert authority and stop women using their own judgment  and knowledge of their babies.

As I said last week, “We have built the perception that breastfeeding is technically challenging and too hard to do without professional help. What happens to a woman’s self-confidence and capacity for decision-making when faced with a conflicting overload of professional help and institution rules?”

We undermine women’s confidence and set them up for breastfeeding failure. We can no more give a mother and baby a step-by-step manual to create that nurturing relationship than we can provide a foolproof instruction book to achieve an orgasm.

Women need to regain confidence in the ability of their bodies to work in tune with their babies. Mothering — and breastfeeding — is not a technical procedure. It is a relationship between two people that grows with mutual trust and intimacy that has extraordinary benefits for our health, economy and society.

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Peter Fray
Peter Fray
Editor-in-chief of Crikey
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