Watch Your Language
By Diane Wiessinger, MS, IBCLC
The lactation consultant says, "You have the best chance to provide
your baby with the best possible start in life, through the special
bond of breastfeeding. The wonderful advantages to you and your baby
will last a lifetime." And then the mother bottlefeeds. Why?
In part because that sales pitch could just as easily have come from
a commercial baby milk pamphlet. When our phrasing and that of the
baby milk industry are interchangeable, one of us is going about it
wrong...and it probably isn't the multinationals. Here is some of the
language that I think subverts our good intentions every time we use
it.
Best possible, ideal, optimal, perfect. Are you the best possible
parent? Is your home life ideal? Do you provide optimal meals? Of
course not. Those are admirable goals, not minimum standards. Let's
rephrase. Is your parenting inadequate? Is your home life subnormal?
Do you provide deficient meals? Now it hurts. You may not expect to
be far above normal, but you certainly don't want to be below normal.
When we (and the artificial milk manufacturers) say that
breastfeeding is the best possible way to feed babies because it
provides their ideal food, perfectly balanced for optimal infant
nutrition, the logical response is, "So what?" Our own experience
tells us that optimal is not necessary. Normal is fine, and implied
in this language is the absolute normalcy--and thus safety and
adequacy--of artificial feeding. The truth is, breastfeeding is
nothing more than normal. Artificial feeding, which is neither the
same nor superior, is therefore deficient, incomplete, and inferior.
Those are difficult words, but they have an appropriate place in our
vocabulary.
Advantages. When we talk about the advantages of breastfeeding--
the "lower rates" of cancer, the "reduced risk" of allergies,
the "enhanced" bonding, the "stronger" immune system--we reinforce
bottlefeeding yet again as the accepted, acceptable norm.
Health comparisons use a biological, not cultural, norm, whether the
deviation is harmful or helpful. Smokers have higher rates of
illness; increasing prenatal folic acid may reduce fetal defects.
Because breastfeeding is the biological norm, breastfed babies are
not "healthier;" artificially-fed babies are ill more often and more
seriously. Breastfed babies do not "smell better;" artificial feeding
results in an abnormal and unpleasant odor that reflects problems in
an infant's gut. We cannot expect to create a breastfeeding culture
if we do not insist on a breastfeeding model of health in both our
language and our literature.
We must not let inverted phrasing by the media and by our peers go
unchallenged. When we fail to describe the hazards of artificial
feeding, we deprive mothers of crucial decision-making information.
The mother having difficulty with breastfeeding may not seek help
just to achieve a "special bonus;" but she may clamor for help if she
knows how much she and her baby stand to lose. She is less likely to
use artificial milk just "to get him used to a bottle" if she knows
that the contents of that bottle cause harm.
Nowhere is the comfortable illusion of bottlefed normalcy more
carefully preserved than in discussions of cognitive development.
When I ask groups of health professionals if they are familiar with
the study on parental smoking and IQ (1), someone always tells me
that the children of smoking mothers had "lower IQs." When I ask
about the study of premature infants fed either human milk or
artificial milk (2), someone always knows that the breastmilk-fed
babies were "smarter." I have never seen either study presented any
other way by the media--or even by the authors themselves. Even
health professionals are shocked when I rephrase the results using
breastfeeding as the norm: the artificially-fed children, like
children of smokers, had lower IQs.
Inverting reality becomes even more misleading when we use
percentages, because the numbers change depending on what we choose
as our standard. If B is 3/4 of A, then a is 4/3 of B. Choose A as
the standard, and B is 25% less. Choose B as the standard, and A is
33 1/3% more. Thus, if an item costing 100 units is put on sale
for "25% less,"the price becomes 75. When the sale is over, and the
item is marked back up, it must be marked up 33 1/3% to get the price
up to 100. Those same figures appear in a recent study (3), which
found a "25% decrease" in breast cancer rates among women who were
breastfed as infants. Restated using breastfed health as the norm,
there was a 33-1/3% increase in breast cancer rates among women who
were artificially fed. Imagine the different impact those two
statements would have on the public.
Special. "Breastfeeding is a special relationship." "Set up a special
nursing corner." In or family, special meals take extra time. Special
occasions mean extra work. Special is nice, but it is complicated, it
is not an ongoing part of life, and it is not something we want to do
very often. For most women, nursing must fit easily into a busy life--
and, of course, it does. "Special" is weaning advice, not
breastfeeding advice.
Breastfeeding is best; artificial milk is second best. Not according
to the World Health Organization. Its hierarchy is: 1) breastfeeding;
2) the mother's own milk expressed and given to her child some other
way; 3) the milk of another human mother; and 4) artificial milk
feeds (4). We need to keep this clear in our own minds and make it
clear to others. "The next best thing to mother herself" comes from a
breast, not from a can. The free sample perched so enticingly on the
shelf at the doctor's office is only the fourth best solution to
breastfeeding problems.
There is a need for standard formula in some situations. Only because
we do not have human milk banks. The person who needs additional
blood does not turn to a fourth-rate substitute; there are blood
banks that provide human blood for human beings. He does not need to
have a special illness to qualify. All he needs is a personal
shortage of blood. Yet only those infants who cannot tolerate fourth
best are privileged enough to receive third best. I wonder what will
happen when a relatively inexpensive commercial blood is designed
that carries a substantially higher health risk than donor blood. Who
will be considered unimportant enough to receive it? When we find
ourselves using artificial milk with a client, let's remind her and
her health care providers that banked human milk ought to be
available. Milk banks are more likely to become part of our culture
if they first become part of our language.
We do not want to make bottlefeeding mothers feel guilty. Guilt is a
concept that many women embrace automatically, even when they know
that circumstances are truly beyond their control. (My mother has
been known to apologize for the weather.)
Women's (nearly) automatic assumption of guilt is evident in their
responses to this scenario: Suppose you have taken a class in
aerodynamics. You have also seen pilots fly planes. Now, imagine that
you are the passenger in a two-seat plane. The pilot has a heart
attack, and it is up to you to fly the plane. You crash. Do you feel
guilty?
The males I asked responded, "No. Knowing about aerodynamics doesn't
mean you can fly an airplane." "No, because I would have done my
best." "No. I might feel really bad about the plane and pilot, but I
wouldn't feel guilty." "No. Planes are complicated to fly, even if
you've seen someone do it." What did the females say? "I wouldn't
feel guilty about the plane, but I might about the pilot because
there was a slight chance that I could have managed to land that
plane." "Yes, because I'm very hard on myself about my mistakes.
Feeling bad and feeling guilty are all mixed up for me." "Yes, I
mean, of course. I know I shouldn't, but I probably would." "Did I
kill someone else? If I didn't kill anyone else, then I don't feel
guilty." Note the phrases "my mistakes," "I know I shouldn't,"
and "Did I kill anyone?" for an event over which these women would
have had no control!
The mother who opts not to breastfeed, or who does not do so as long
as she planned, is doing the best she can with the resources at hand.
She may have had the standard "breast is best" spiel (the course in
aerodynamics) and she may have seen a few mothers nursing at the mall
(like watching the pilot on the plane's overhead screen). That is
clearly not enough information or training. But she may still feel
guilty. She's female.
Most of us have seen well-informed mothers struggle unsuccessfully to
establish breastfeeding, and turn to bottlefeeding with a sense of
acceptance because they know they did their best. And we have seen
less well-informed mothers later rage against a system that did not
give them the resources they later discovered they needed. Help a
mother who says she feels guilty to analyze her feelings, and you may
uncover a very different emotion. Someone long ago handed these
mothers the word "guilt." It is the wrong word.
Try this on: You have been crippled in a serious accident. Your
physicians and physical therapists explain that learning to walk
again would involve months of extremely painful and difficult work
with no guarantee of success. They help you adjust to life in a
wheelchair, and support you through the difficulties that result.
Twenty years later, when your legs have withered beyond all hope, you
meet someone whose accident matched your own. "It was difficult," she
says. "It was three months of sheer hell. But I've been walking every
since." Would you feel guilty?
Women to whom I posed this scenario told me they would feel angry,
betrayed, cheated. They would wish they could do it over with better
information. They would feel regret for opportunities lost. Some of
the women said they would feel guilty for not having sought out more
opinions, for not having persevered in the absence of information and
support. But gender-engendered guilt aside, we do not feel guilty
about having been deprived of a pleasure. The mother who does not
breastfeed impairs her own health, increases the difficulty and
expense of infant and child rearing, and dismisses one of life's most
delightful relationships. She has lost something basic to her own
well-being. What image of the satisfactions of breastfeeding do we
convey when we use the word "guilt"?
Let's rephrase, using the words women themselves gave me: "We don't
want to make bottlefeeding mothers feel angry. We don't want to make
them feel betrayed. We don't want to make them feel cheated." Peel
back the layered implications of "we don't want to make them feel
guilty," and you will find a system trying to cover its own tracks.
It is not trying to protect her. It is trying to protect itself.
Let's level with mothers, support them when breastfeeding doesn't
work, and help them move beyond this inaccurate and ineffective word.
Pros and cons, advantages and disadvantages. Breastfeeding is a
straight-forward health issue, not one of two equivalent
choices. "One disadvantage of not smoking is that you are more likely
to find secondhand smoke annoying. One advantage of smoking is that
it can contribute to weight loss." The real issue is differential
morbidity and mortality. The rest--whether we are talking about
tobacco or commercial baby milks--is just smoke.
One maternity center uses a "balanced" approach on an "infant feeding
preference card" (5) that lists odorless stools and a return of the
uterus to its normal size on the five lines of breastfeeding
advantages. (Does this mean the bottlefeeding mother's uterus never
returns to normal?) Leaking breasts and an inability to see how much
the baby is getting are included on the four lines of disadvantages.
A formula-feeding advantage is that some mothers find it "less
inhibiting and embarrassing." The maternity facility reported good
acceptance by the pediatric medical staff and no marked change in the
rates of breastfeeding or bottlefeeding. That is not surprising. The
information is not substantially different from the "balanced" lists
that the artificial milk salesmen have peddled for years. It is
probably an even better sales pitch because it now carries very clear
hospital endorsement. "Fully informed," the mother now feels
confident making a life-long health decision based on relative diaper
smells and the amount of skin that shows during feedings.
Why do the commercial baby milk companies offer pro and con lists
that acknowledge some of their product's shortcomings? Because
any "balanced" approach that is presented in a heavily biased culture
automatically supports the bias. If A and B are nearly equivalent,
and if more than 90% of mothers ultimately choose B, as mothers in
the United States do (according to an unpublished 1992 Mothers'
Survey by Ross Laboratories that indicated fewer than 10% of U.S.
mothers nursing at a year), it makes sense to follow the majority. If
there were an important difference, surely the health profession
would make a point of staying out of the decision-making process. It
is the parents' choice to make. True. But deliberately stepping out
of the process implies that the "balanced" list was accurate. In a
recent issue of Parenting magazine, a pediatrician comments, "When I
first visit a new mother in the hospital, I ask, 'Are you
breastfeeding or bottlefeeding?' If she says she is going to
bottlefeed, I nod and move on to my next questions. Supporting new
parents means supporting them in whatever choices they make; you
don't march in postpartum and tell someone she's making a terrible
mistake, depriving herself and her child." (6)
Yet if a woman announced to her doctor, midway through a routine
physical examination, that she took up smoking a few days earlier,
the physician would make sure she understood the hazards, reasoning
that now was the easiest time for her to change her mind. It is
hypocritical and irresponsible to take a clear position on smoking
and "let parents decide" about breastfeeding without first making
sure of their information base. Life choices are always the
individual's to make. That does not mean his or her information
sources should be mute, nor that the parents who opt for
bottlefeeding should be denied information that might prompt a
different decision with a subsequent child.
Breastfeeding. Most other mammals never even see their own milk, and
I doubt that any other mammalian mother deliberately "feeds" her
young by basing her nursing intervals on what she infers the baby's
hunger level to be. Nursing quiets her young and no doubt feels good.
We are the only mammal that consciously uses nursing to transfer
calories...and we're the only mammal that has chronic trouble making
that transfer.
Women may say they "breastfed" for three months, but they usually say
they "nursed" for three years. Easy, long-term breastfeeding involves
forgetting about the "breast" and the "feeding" (and the duration,
and the interval, and the transmission of the right nutrients in the
right amounts, and the difference between nutritive and non-nutritive
suckling needs, all of which form the focus of artificial milk
pamphlets) and focusing instead on the relationship. Let's all tell
mothers that we hope they won't "breastfeed"--that the real joys and
satisfactions of the experience begin when they stop "breastfeeding"
and start mothering at the breast.
All of us within the profession want breastfeeding to be our
biological reference point. We want it to be the cultural norm; we
want human milk to be made available to all human babies, regardless
of other circumstances. A vital first step toward achieving those
goals is within immediate reach of every one of us. All we have to do
is...watch our language.
If you found this article of interest, you may desire to ensure you
regularly receive your own copy of the Journal of Human Lactation
(JHL). Taking out membership in the International Lactation
Consultant Association(ILCA)includes the benefit of four issues of
the JHL a year. See www.ilca.org for how to join.
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