My friend brought her three-week-old over the other day. We ogled over his squishiness, crinkled ears, and sweet baby scent. He was nursing well, doing his newborn thing.
Even more, my friend felt confident about breastfeeding. She pointed out his feeding cues and nursed him comfortably several times during our visit. Everything seemed to be going wonderfully.
The first time I asked my friend how she was doing, she reported she was doing great too. Her response was automated yet cheerful; the way many new moms feel obligated to reply.
Not long into our visit though, she said this about her birth experience: “By the end of it all, I just felt like tearing my birth plan to shreds.”
Sadness and regret engulfed her. Things weren’t as wonderful as they seemed. My heart broke for her.
Evidence vs. routine
This encounter and my most recent Lactation Counselor Training reminded me about UNlearning and the urgency for evidence-based practice to become policy.
Looking into my friend’s sad eyes was the end result of health care providers not practicing based on evidence. Instead, routine took over her birth experience.
We know a lot about how to help moms be successful at breastfeeding (and that includes respectful birth practices.) There’s no excuse not to make birth and breastfeeding a priority especially considering breastfeeding “…may be the single best investment a country can make,” as World Bank Global Practices Vice President Keith Hansen recently put it.
When I retook The Lactation Counselor Training to brush up on my counseling skills, I expected all of my breastfeeding knowledge to be up-to-date, because I am very new to the field. I never thought I’d have my own unlearning to do. As it turns out, I was wrong. That was a strange feeling. There is a lot that I don’t know about human lactation and breastfeeding, but I never expected that some of what I do know was inaccurate and potentially harmful.
One of our instructors, Jenny Spang, reminded our class not to get hung up on the false information we may have spread. She acknowledged that, as care providers, we may be overcome by guilt for advising mothers incorrectly. We might even grieve for the old information we must discard.
With these internal battles in mind, Jenny offered this advice from Maya Angelou: “When you know better, do better.”
Solving mysteries, busting myths
The Academy of Lactation Policy and Practice’s (TALPP) Code of Ethics expects all CLCs to practice based on the most up-to-date evidence. Breastfeeding myths and misconceptions abound even within professional circles, so it is important for care providers to seek out opportunities for new learning and collaboration. It is not OK to find one study that supports our belief– we must look at the larger body of evolving evidence.
Here’s the thing: as lactation care providers, we’re never finished learning. There will always be something new. Throughout both of the Lactation Counselor Training Courses I participated in, this idea that “We need to know more” came up quite often (which, I must add, is mind-boggling because the course is packed with a week’s worth of fascinating and practical maternal child health information.)
Lisa Ann Marasco, author of Unsolved Mysteries of the Human Mammary Gland: Defining and Redefining the Critical Questions from the Lactation Consultant’s Perspective, points out the potential problems with the “unsolved mysteries” surrounding human lactation and breastfeeding.
“…Desperate mothers may turn to non-evidence-based remedies, sometimes at considerable cost and unknown risk,” Marasco writes. “Research targeted to these clinical dilemmas is critical in order to develop evidence-based strategies and increase breastfeeding duration and success rates.”
What we don’t know
In the spirit of learning more, during my most recent training, I kept track of research that still needs to be done and/or built upon. I also included things participants were simply curious about. These mysteries, if solved, may add to our growing understanding of how to better help mothers and babies breastfeed.
Before I share the list, I’d like to direct your attention to an Evidence Based Birth Facebook status with great practical advice about “research.” Of course childbirth and breastfeeding are interchangeable in this context.
**Important tip** Whenever you come across an article online that claims to offer important information about childbirth, ask yourself these questions: 1) Does the author offer opinions or research evidence? 2) Is the author a qualified professional, and has the article been reviewed by midwifery or medical experts in the field? 3) Does the article cite recent, relevant research sources, and 4) Does the author use non-biased language? If your answer to any of these is “no,” then I would take great caution in listening to what the author has to say. Best way to protect yourself from “bad” information is to talk about any birth information you read online with your own, qualified health care professional.
So, what don’t we know?
- There’s the myriad of breastfeeding challenges Marasco points out in Unsolved Mysteries of the Human Mammary Gland: Defining and Redefining the Critical Questions from the Lactation Consultant’s Perspective.
- One study shows that when a father shares a bed with a pregnant partner, his prolactin levels increase. Do prolactin levels increase in siblings who also bedshare? In same-sex couples who bed share?
- What are the effects of placenta encapsulation on lactation and milk production? http://www.scienceandsensibility.org/placentophagy-a-pop-culture-phenomenon-or-an-evidence-based-practice/
- How does marijuana use affect lactation and breastfeeding? http://toxnet.nlm.nih.gov/cgi-bin/sis/search2/f?./temp/~vfupYC:1
- Why do some women have inverted nipples?
- Is it safe for mothers to breastfeed their babies on a breast affected by abscess? Is it safe to breastfeed on the affected side after “lancing”?
- What affects do pharmacologic pain relief methods during labor have on lactation and the breastfeeding dyad? http://www.bfmed.org/Media/Files/Protocols/Protocol_15_revised_2012.pdf
- What affect does maternal intravenous fluid have on lactation and breastfeeding? http://www.internationalbreastfeedingjournal.com/content/pdf/s13006-015-0043-8.pdf
- What are the effects of nipple shields on milk production?
- Do nipple shields develop harmful biofilm similar to the way pacifiers do?
- Are retained placental fragments more common in c-section or vaginal deliveries?
- What drives Lactogenesis 4, when prolactin levels are presumably lower?
- Does early allergen exposure during breastfeeding lower the risk of childhood allergy? http://well.blogs.nytimes.com/2014/02/03/as-peanut-allergies-rise-trying-to-determine-a-cause/
- How can we better assist mothers who wish to induce lactation? http://www.asklenore.info/breastfeeding/induced_lactation/gn_protocols.shtml
What are you curious about? What would you add to this list?