“Our research suggests that the use of risk language is premature at this point because it has not been well evaluated, and the evaluations that have been done suggest that it doesn’t increase breastfeeding among people exposed to it,” Dr. Wallace said. “There is some suggestion from qualitative research that you can create a backlash to the information.”
The thinking behind risk language is that using stronger language to encourage breastfeeding will somehow make more women choose to do it, but such a rationale ignores the fact that parents are already trying to do the absolute best they can for their children, Dr. Wallace said.
“I don’t think the research supports the idea that women aren’t breastfeeding because they don’t know it’s good for their babies,” she said. “They’re not breastfeeding because it’s hard because of the way we structure our society and our workplaces.”
Another statement to avoid is “every woman can breastfeed,” said Laura Lallande, the lactation services coordinator at Oregon Health and Science University, Portland.
“There are real, legitimate physical reasons some women cannot or choose not to breastfeed, and we need to stop propagating the myth that formula feeding is equivalent to moral failure,” Ms. Lallande said. “As with anything in health care, our job is to meet clients where they are, not where we want them to be. If we start from a point of judgment, we block progress before it starts.”
Potential sources of shame
It is the “everyone can if you try hard enough” language that can lead to shame, Dr. Stuebe said.
The feelings of shame some women may feel if they don’t breastfeed can arise from the inappropriate conflation of breastfeeding and being a good mother. “Particularly for first-time mothers, the transition from what I want to be as a parent to what I can be as a parent is wrenching for some women,” Dr. Stuebe said.
The social infrastructure in the United States means that breastfeeding is not actually a “choice” for all women, Dr. Stuebe said. This reality is reflected in the ACOG statement, which encourages ob.gyns. to “be in the forefront of policy efforts to enable women to breastfeed, whether through individual patient education, change in hospital practices, community efforts, or supportive legislation” and to promote policies that accommodate milk expression, such as paid maternity leave, on-site child care, break time, and a location other than a bathroom for expressing milk.
Even the way the health care system is set up makes it hard for mothers to get holistic care, Dr. Stuebe said.
“What happens is moms get conflicting advice from [their] provider and the baby’s provider, and sometimes even from a third source such as a lactation consultant, and they’re left trying to triangulate that information,” Dr. Stuebe said. “Nobody is saying, ‘How is this whole mother doing and how can we meet her needs?’ ”
That’s why it’s important to follow up with patients and ask how breastfeeding is going, Dr. Stuebe explained. If it’s not working out, women need to know it’s okay to stop.
“Breast milk is important, but a woman’s well-being is also important and if everything about breastfeeding is awful, that’s not helping her or her baby,” Dr. Stuebe said.
Physicians have a responsibility to tell women that breastfeeding is advantageous, Dr. Wallace said, but they also have a responsibility to listen to patients and be sensitive to what they’re hearing.
“To the parent in the moment, if they’re facing something really important about employment or housing, the breastfeeding decision may not look as important to them,” Dr. Wallace said.
Yet ob.gyns. should never discount how critical their role is in helping mothers successfully breastfeed if they choose to, Ms. Lallande said.
“Even when things are great, breastfeeding is physically and emotionally challenging,” Ms. Lallande said. “Women need support from providers who listen to them and help them navigate the sleep-deprived early weeks of motherhood. Especially with first-time moms, the relationship with the OB is much stronger than the relationship with the pediatrician, so they call the OB for help.”