A personal choice which is influenced by a number of factors and experiences – but all too often the option of a choice is an illusion.
Choice is limited by health systems, researchers, and providers who, unfortunately, lack the necessary knowledge and investment to get to the root cause of so many lactation and infant feeding difficulties. Instead we shrug and move on saying, "Some women can't breastfeed."
This does not come from malice.
It does come from a lack of prioritization, limited resources, and typically only informal training which does not create foundations of understanding for how truly necessary human milk is for human babies. We do not tie conditions like colic, allergies, excessive crying, and long-term health conditions back to if and for how long a person received human milk.
We don't see the connection.
All too often the responsibility for "breastfeeding failure" is placed upon the parent without recognizing that the systems, protocols, and shockingly insufficient outpatient services are primary drivers for parents not meeting their feeding goals.
Beyond the healthcare system, the national failure to provide a standard of living which meets the needs of individuals greatly increases risk of short duration of infant feeding. How can you focus on pregnancy recovery, infant bonding, and human milk feeding when one's housing, income, and nutrition is at risk?
Culturally, we expect individual success or failure but we don't live independently. It's all interconnected and humanity did not survive this long as individuals - but as societies with built in social structures.
What do we do about this? I've got some ideas:
1. Institute the 2009 recommended undergraduate education from WHO and the UN Children's Fund for all nurses and physicians.
2. Pregnancy screening and consultation with IBCLCs to identify social factors & medical conditions which may impact milk production or infant care for all pregnant patients.
3. Medical screening during pregnancy for known and suspected hormonal and metabolic conditions to begin therapy and offer specific counseling during pregnancy.
4. Individual and group education for feeding preparation using evidence-based curriculum as standard practice for all pregnant patients.
5. Increase at-home lactation care in the postpartum period through utilization of doulas and home health nurses to screen for problems and make referrals to IBCLCs for issues beyond the scope of doulas and RNs.
6. Utilize IBCLCs in primary care settings throughout the pregnancy and postpartum.
7. Increase peer-to-peer support groups to create hospitable and supportive environments from pregnancy through early childhood which are facilitated by educated peers who can assess and refer for medical, mental, and physical needs which impact young families.
8. Expand IBCLC coverage with fair reimbursement for all plans including Medicaid.
9 & 10...what would you add to this list?