“Where is the mother in the discussion?” An interview with Walker Karraa on maternal mental health and infant feeding

Some of you may know Walker Karraa from her comments on our Facebook community page, or from her fantastic posts on Science & Sensibility. But I doubt you’re aware of the full magnitude of her bravery and dedication to issues surrounding maternal mental health. I recently interviewed Walker for a short piece on formula feeding and postpartum adjustment, and was so blown away by her answers – I was only able to use a few of her wise words due to word count constraints, so I’m thrilled she’s agreed to let me post the interview in full here on FFF.

Walker is a doctoral candidate at Sofia University, where she is conducting a study on the transformational dimensions of postpartum depression. She was also the founding President of PATTCh, an organization founded by Penny Simkin dedicated to the prevention and treatment of traumatic childbirth, and is a perinatal mental health contributor for Lamaze International’s Science and Sensibility, Giving Birth With Confidence, and the American College of Nurse-Midwives (ACNM) Midwives Connection. Like that wasn’t enough on her plate, Walker also served as social media manager for the Integral Leadership Review, and has her own social media consulting business, On My High Horse, and is currently working toward co-authoring a book regarding PTSD following childbirth with Kathleen Kendall-Tackett, Ph.D., IBCLC, FAPA. 

I’m exhausted just reporting all of that. And did I mention she has two kids and is a breast cancer survivor? Yeah, she’s all that and a bag of reduced fat potato chips.

I hope you guys will appreciate the revolutionary nature of Walker’s discussion here – her opinions, while brilliant, probably seem uncontroversial to those who follow this blog, but they are quite “rogue” in the birth/maternal-child health community. I can’t thank her enough for being a dissenting voice and speaking up for the benefit of all women. 

FFF: Here on FFF, we see stories almost weekly which discuss how a perceived “failure” to breastfeed can lead to depression, anxiety, and self-esteem issues. Do you think the maternal mental health community has recognized how breastfeeding (or lack thereof) can affect the emotional state of new moms?

Walker Karraa

WK: I think that overall breastfeeding is very well addressed in the health psychology, and developmental psychology fields. What’s lacking is the reframe of the research to integrate more qualitative data, and methods, into the consideration of the full range of implications of breastfeeding from multiple perspectives—including the woman’s perspective.

In a 1985 Lancet article on maternal mortality, Allen Rosenfield asked the famous question, “Where is the ‘M’ in MCH (Maternal Child Health)? In the discussions of MCH, it is commonly assumed that what is good for the child is good for the mother.” (Rosenfield & Maine, 1985, p. 83). In many ways this is relevant in the discussion of breastfeeding and maternal mental health. Where is the mother in the discussion? And in what ways do we still assume what is good for the child is good for the mother? For me, this is all about reproductive rights and a deeper issue about our discomfort with women’s sovereignty over their reproductive, physical, and mental health.

The mental health community has responded to the growth in published data regarding infant health and breastfeeding. This has also been the funding stream for a large part of the last 20 years. But maternal mental health has yet to directly address a woman’s infant feeding choice as a part of her reproductive choice, rather than discrete periods of time that occur with as a continuum of events that are inextricably woven through reproductive events—none of which, taken by themselves, gives either the best data on mental health.

FFF: What do you feel needs to change in order for new mothers to be better supported in terms of mental health in general?

WK: I think one of the first calls to action must be for maternal care providers to get support in knowing that perinatal mood and anxiety disorders are common and create the conditions for morbidity and mortality for mother and children. This is starting to happen, but still very slow. I think new models of medical care such as Dr. Michael C Lu’s life course model, which places the woman at the center of care, not the doctor. And, she is treated across the lifespan, not merely when she is pregnant. This facilitates better reproductive health in preconception and interconception, and uses a reproductive life plan for women and families from an early age. At puberty, to have a conversation with medical, nutritional, mental health providers as to planning one’s reproduction (girls and boys) would be ideal.

FFF: Many women struggle with the decision of whether to treat postpartum or prenatal depression/anxiety with psycho-pharmaceuticals, especially when they are breastfeeding. Why is there such mixed information and messaging about what drugs are safe, and what the relative risks are (ie, breastfeeding without meds vs breastfeeding on meds vs formula feeding and taking the meds)?

WK: Not having good information is a barrier to care for everyone involved. The OB/GYN or midwife, the social worker, the woman, her partner and family—when we don’t have good information, we cannot make informed choices. And for women in poverty, the risk is twofold. Specifically regarding breastfeeding, but also education across the board regarding psychopharmacology, pregnancy, and lactation. With organizations such as OTIS (Organization of Teratology Information Specialists) and Motherisk, there really is no excuse for not having current evidence-based data regarding risk and benefit of untreated depression and anxiety, as well as risks and benefits of medications used to treat them.

Byatt et al. (2012) did a wonderful grounded theory study regarding community mental health provider reluctance to providing psycho-pharmacotherapy. 28 obstetric care providers (nurses, OB/Gyns, etc.) shared how they perceive community mental health practitioners as obstacles to psychopharmacology for perinatal women. The participants felt community mental health providers “99% of the time” discontinued a patients’ medication, and put women at risk of relapse. Secondly, Byatt et al., (2012) reported that participants perceived a lack of collaboration and communication between community mental health care providers and OB/Gyn providers, and that pharmacists also “further impede or delay depression treatment by not filling needed psychotropic prescriptions, often exacerbating women’s mental health symptoms” (p. 3).

FFF: Why do you think so many women express grief, guilt, and feelings of failure around the subject of infant feeding?

WK: Because that is their experience! And I attribute all of it to social constructs that are completely ingrained in medical, social, and mental health systems that have been made for and by men. The intentions of those men is not necessarily nefarious, and not really the point. It is that the constructs we have to measure ourselves (abilities and weaknesses) are made by men. We tell women from the get-go that they need us to be good mothers. They need our insight, knowledge, treatment, book, video, technique, services, product to be taught how to mother. This is so ironic, because so many of the birth movements have evolved from a call to empower women. But to empower, we have just made more systems of knowledge that mimic the ones we refute. That is not very popular to say, but it is true. The messages still given to women is that if they “know” something analytically, they are devoid of femininity, and if they “know” something inter-subjectively, they are devoid of ration.

Shame is a powerful force for women. And at no time in her life is a woman more susceptible to shame than early motherhood. If they are lucky enough to find a safe space to share their feelings without judgment, such as your blog, they are given the gift of voice. They can speak their truths.

FFF: Any tips for a mom who is having a tough time reconciling her use of formula?

WK: You know, when I was a doula, I had clients ask me to go buy formula for them so they wouldn’t be seen in public. When I was diagnosed with breast cancer shortly after the birth of my second, I underwent two mastectomies before she had turned one. I learned that my body parts have nothing to do with my inherent ability to love her. My breasts were gone—off of my body, one in one hospital and another at a hospital down the road. I fed, nurtured, attached with, loved, and parented without them…and still do! So my advice is to write down on a piece of paper: My breasts have nothing to do with my love for my child. And keep it where you can see it. Memorize it, know it.

FFF Friday: “If someone wants to judge me…that’s their choice.”

Welcome to Fearless Formula Feeder Fridays, a weekly guest post feature that strives to build a supportive community of parents united through our common experiences, open minds, and frustration with the breast-vs-bottle bullying and bullcrap.

Please note, these stories are for the most part unedited, and do not necessarily represent the FFF’s opinions. They also are not political statements – this is an arena for people to share their thoughts, and I hope we can all give them the space to do so.



D-MER, or Dysphoric Milk Ejection Reflex, is a problem that is seldom discussed in breastfeeding literature. It’s a tricky condition to diagnose, because other things can make breastfeeding a negative experience – postpartum depression, psychological responses to physical pain or sensations, associations with past abuse, body image issues…  D-MER, however, causes a “dysphoric” response (depression, anxiety, anger, negativity) with milk let-down, and it typically subsides as soon as that physiological process ends. In my opinion, this is a vastly under-diagnosed condition due to the perception that these feelings are shameful or “abnormal”, because we are told that breastfeeding should be a lovely, enjoyable bonding experience. Further, the vast majority of D-MER resources operate under the assumption that weaning is not an option, and that it can be resolved through medication. For those who want to continue breastfeeding, this is wonderful – but for those who do not feel comfortable taking certain medications while nursing, or at all, this advice may cause more frustration than comfort. 

FFF Andrea’s story, which unfolds below, demonstrates the conflicted feelings of a woman who wants to breastfeed, but also wants the happy, emotionally-attuned family life she so deserves. I hope that her willingness to share her journey will encourage other women living with D-MER to come out of the closet regarding their true feelings and experiences. This is a real problem, affecting real women, and it’s time we had some real, honest discussions about it – because in many ways, it is the most literal “booby trap” of them all.

Happy Friday, fearless ones….

The FFF
***

Andrea’s Story
I formula fed my first and for the most part didn’t mind.  I knew he was turning out healthy and he was advanced for his age too.  I had no doubt that formula was a good alternative for those that didn’t want to or couldn’t breastfeed.  However a part of me always sort of wished breastfeeding worked out for me.  However I had depression only during breastfeeding and it just got worse as the days went on.  After a bit of research sometime later I found out that it was D-MER and was a bit relieved that I wasn’t abnormal and others experienced it too.
Fast forward a couple years and we had our second on the way.  I hoped that breastfeeding would work out and was determined off and on to exclusively breastfeed.  I researched D-MER and found out that if you had it before you would likely get it again.  That thought scared me quite a bit because I remembered how miserable I felt and the dread I felt before he latched on.  I found out that Wellbutrin had some good results with D-MER though and started researching the use of Wellbutrin while breastfeeding.  I took it for ADD already with great results, but had stopped before I got pregnant.  However, I just couldn’t find enough research to make me feel comfortable with that.  I knew only a little transferred through the milk, but I couldn’t help but wonder how much it affected a baby’s brain since they were so tiny and still developing quite a bit.  My education background made me wary as well.  To me, formula honestly seems to be a much safer alternative because it doesn’t have a drug in it that affects the dopamine levels in her brain.
Fast forward again and my daughter was born at a very healthy 7.11 pounds and 20.5 inches.  She had (still does have) the cutest chubby cheeks!  I decided to go ahead and let her latch on and she did, very fast and pretty good, too.  I remember telling the doula that we would take it one day at a time and wistfully stating that I hoped it would work out.  It was an experience I wanted to have.  I knew I’d bond with her just as well with formula; in fact it would be better than breastfeeding if the depression came.  We were in the hospital for 2 days and she breastfed really well; in fact I’d say she had a voracious appetite.  She had a wonderful latch, but she went at each feed so thoroughly that I got peeling and cracked nipples.  It only hurt when she latched on fortunately and sometimes that was because she’d just inhale the nipple.  On the third day I was pretty much couch- bound with a baby that was feeding pretty often for short cluster feeds.  If she wasn’t feeding she was using me as a paci or insisted on sleeping with her head right next to the nipple.  I could get up to maybe use the bathroom, but that was it.  My milk had started coming in and I began to feel those same depressing thoughts and I had some random bouts of anxiety as well.  Faint as they were at that moment, it was still undesirable.  I also found myself really hating the couch-bound aspect.  I couldn’t find a position that didn’t hurt since I had a couple stitches.  I also had a son that needed me.  My husband was helping out a ton, but my son insisted on having me help him go to bed at night and to pat him back to sleep if he woke up.  I wanted to be with him at bedtime and more as well, but with the way my daughter was feeding, it was very hard.  So midway into the third day we switched to formula.  Admittedly I felt relieved.  I wasn’t tied to the couch and my mood started improving with the slowly diminishing letdowns.  The more my milk dried up the better I felt.
A few days later though it was clear the formula wasn’t agreeing with her.  She was comfort feeding so much that she would drink about 6 ounces over a couple hours between fussing.  Then she’d cry and fuss herself to sleep.  We tried paci’s and all, but she wouldn’t take them.  I also noticed that she had silent reflux.  I decided to try Similac Sensitive since that was what my son was on.  I remembered that he didn’t do well on Enfamil Gentlease so maybe it would be the same with our daughter.  It seemed like she improved briefly, but she actually got worse.  So as a last option I bought a can of Alimentum and gave that a shot.  She started doing so much better.  It was an amazing improvement.  I fell in love with the formula, she is such a happy and calm baby now.  She does just as well on Nutramigen as well, which is a bit more affordable.
Part of me felt bad though.  I occasionally wonder if she’d have had this problem if she were breastfed.  I also wished a bit that breastfeeding had worked out.  I wanted that experience and the convenience as well.  I felt a bit guilty that I enjoyed holding my daughter more now that she wasn’t attached to me and voraciously feeding almost all the time as well.  She had such a high demand and was always tugging and pulling at me as well as feeding quite hard at times. 
I can’t help wonder if some of the guilt I feel is because all my friends breastfeed.  The only person I could talk to about the whole breast or formula dilemma while pregnant was with my mom, who had done both with my brother and me.  I tried talking to a friend, but she wasn’t very helpful.  I got some clear anti formula comments from another friend as well.  I laughed it off, but it did hurt a bit.  I know part of me feels envious because I did hope it would have worked out.  It’s just an experience I wanted to have that wasn’t tainted with depression or random bouts of abnormal anxiety.  At this current moment I’m trying hard to not get down that it didn’t work out.  It is so nice that my husband can help with feedings.  It’s nice that I don’t have a baby attached to me almost all day as well. It’s especially nice that my mood isn’t going downhill and that I won’t wonder someday if the Wellbutrin changed her brain at all.  I can help out more with our son too.  I do enjoy feeding her much more now.  It’s a wonderful bonding experience and as I say, since you need two hands for feeding with a bottle you can’t read a book or surf the web like you can while breastfeeding.  Sure you can watch TV, but I rarely pay attention to that, I love watching her and it helps keep me aware of her cues on when she needs to burp or is done. 
Overall, I know that this is better for me emotionally.  While most don’t understand DMER or why I won’t breastfeed while taking Wellbutrin, I know the truth.  If someone wants to judge me on my reason for not breastfeeding, that’s their choice.  I hope that someday moms won’t feel this huge push for breastfeeding and have more support for formula feeding.  We have enough to deal with as moms, how one chooses to feed their baby shouldn’t be one of those nerve-wracking issues that can be laced with guilt if the choice isn’t breastfeeding.
***
Share your own experience for an upcoming FFF Friday. Email me at: formulafeeders@gmail.com.

Dirty Milk

FFF Sarah, who is currently trying to induce lactation for her upcoming adoption, emailed me this afternoon with an interesting question:

So, I’m pumping all of this crap into my body in an attempt to see if I’m able to lactate.

Today, I was telling my husband why I buy x-type of dairy milk (b/c it doesn’t have rBGH)…I read him this tidbit from the dairy’s page:

rBGH is “recombinant bovine growth hormone” and also known as recombinant bovine somatotropin (rBST). Developed by Monsanto Corporation, rBGH is an artificial hormone that causes cows to artificially increase milk production.

We love our cows and believe that pure, natural milk tastes best and is healthiest for you. Here at Brown’s, our cows are not treated with artificial growth hormones like rBGH.

He said…”um…isn’t that what you’re doing? Taking stuff to artificially increase milk production? How is that good for a kid then?” I said I thought the ingredients were better, but honestly…I don’t know. Is it better? Do we know the danger of Reglan or Domperidone or Fenugreek or Blessed Thistle or any of the other crap we take in order to make milk or more milk for our babies?

Honestly, I had no idea how to answer this; however, I thought it was one of the most interesting questions I’d ever been asked. Even the mere concept of rBGH-free milk is worth talking about, and I can’t believe I’ve never thought about it before. Of course, we’ve discussed the fact that breastmilk can be a veritable smorgasboard of chemicals; in fact, scientists use this particular bodily substance for bio-monitoring (a way of measuring how many toxins are being stored in the human body). Typically, this concern is squashed by folks telling us not to worry, breastmilk is so amazing that it counteracts or cancels out all the bad stuff, or yelling at us not to peek at the man behind the curtain, like the titular dude in Wizard of Oz. (Read this article from Mothering.com to gain a frustrating, bang-your-head-against-the-wall understanding of why some breastfeeding advocates are fighting the trend of using breastmilk in bio-monitoring.)

So, isn’t it kind of funny that everyone is so concerned with the mercury in fish; the hormones in beef and milk… and not the food our own bodies produce?

There is ample proof that what we eat, breathe and absorb goes through our breastmilk. In fact, the NRDC has an entire website dedicated to the chemicals present in breastmilk, and they admit that “infant formula contains far lower quantities of dioxins, PCBs and organochlorine pesticides than breastmilk”. Of course, they go on to assure mothers that “formula has serious drawbacks that tip the scale against it”, and then list all the “risks” we have discussed on this blog, time and time again. The chemical contamination dangers they cite pertaining to formula are “contamination with substances such as broken glass, fragments of metal and salmonella and other bacteria. The fungal toxin aflatoxin has also been detected in some commercial formulas. Although detected levels were very low, this toxin is known to cause cancer and is not present in breast milk. Infant formulas also may contain excessive levels of metals, including aluminum, manganese, cadmium and lead.” However, many of these contaminants are avoidable if we could improve manufacturing processes; the first few listed, when discovered, led to recalls.

The important message here should not be choose formula over breastmilk, or vice versa. It should be, let’s all become more aware of the chemicals our babies are exposed to. Formula is a product; if we want to discuss the chemical contaminants in formula, we can address manufacturing processes, corporate responsibility, quality assurances, ingredient sources, etc. If we want to discuss the chemical contaminants in breastmilk… well, chances are we won’t be discussing that, because its tantamount to yelling fire in a crowded movie theater. Us girls are, like, panicky and hysterical, dontcha know?

Back to the original question which spawned this post, though. It’s one thing to worry about chemicals we have no real control over; quite another to discuss intentionally ingesting something potentially harmful to increase milk supply or induce lactation in the name of Liquid Gold. But could Reglan, Domperidone, Fenugreek, or Blessed Thistle really be harmful? Doctors prescribe them for nursing women all the time, and these folks would never prescribe something that they don’t know 100% for certain won’t harm a baby, right?

(Pause for diabolical laughter…)

Fenugreek and Blessed Thistle are probably the least concerning of these substances, as they are herbal remedies. However, while NIH’s Medline Plus cites “increasing breastmilk quantities” as one of Blessed Thistle’s uses, they also warn, “Don’t take blessed thistle by mouth if you are pregnant. There is some evidence that it might not be safe during pregnancy. It’s also best to avoid blessed thistle if you are breast-feeding. Not enough is known about the safety of this product” and list “irritat(ion of) the stomach and intestines” as a possible side effect. As for Fenugreek, Kellymom warns that while “(m)ost of the time, baby is unaffected by mom’s use of fenugreek (except that more milk is usually available)”, sometimes “baby will smell like maple syrup…some moms have noticed that baby is fussy and/or has green, watery stools when mom is taking fenugreek and the symptoms go away when mom discontinues the fenugreek. Fenugreek can cause GI symptoms in mom (upset stomach, diarrhea), so it’s possible for it to cause GI symptoms in baby too.” A search on WebMD’s database found that “(s)ome reports have linked fenugreek tea to loss of consciousness in children”.

(I feel I should interject here to remind everybody that just like everything else we discuss on here, we should look at these warnings in terms of relative risk. If you read the possible side effects on a bottle of Children’s Advil, it’s a hell of a lot scarier. I’m merely trying to illustrate a point, so bear with me, please, and don’t panic if you’ve been binge-drinking Fenugreek tea.)

Reglan and Domperidone carry more severe warnings. Reglan is one of those drugs that repeatedly come up on litigator’s websites (never a comforting sign), and it has been suggested that it can cause a condition called Tardive Dyskinesia. As one of the litigators explains, “Before Reglan was released, the FDA only approved its use for 12 weeks at a time, which means that women who are breastfeeding are at an even higher risk for developing TD because of the timeframe spent breastfeeding.” (Ironically, I found a really great opinion piece about the relative risks of Reglan on another of these lawyer sites. Go figure.) Perhaps a more real-world concern – and definitely one that worries me a great deal, what with PPD being such a real threat to new moms – Reglan is also linked with depression.

Domperidone, a drug typically used for cancer patients or those with gastrointestinal issues, does seem to be a safer bet, although on a UK site detailing the prescription use of Domperidone, it clearly states that “this medicine passes into breast milk in very small amounts that are not expected to be harmful to a nursing infant. However, the medicine is not recommended for use in women who are breastfeeding unless the potential benefit to the mother outweighs any risks to the nursing infant. Seek medical advice from your doctor.” If that doctor happens to be breastfeeding guru Jack Newman, you’ll be reassured that it is indeed safe (“Worldwide experience with domperidone over at least two decades suggests that long-term side effects also are rare. Some of the mothers in our clinic, breastfeeding adopted babies, have been on the medication for 18 months without any apparent side effects…patients using domperidone for stomach disorders may be on it for many years. I hope you won’t need domperidone for very long, but if it’s necessary and helpful, stay on it,” he breezily suggests, adding links to back him up (nearly all of which are dead links, btw, save for one study which simply proves that Domperidone increases milk supply. Sort of a moot point, don’t you think?)

If a mom needed to take either of these drugs for a medical condition, I would think the benefits absolutely outweigh the risks. Aside from the depression risk, neither seems to be that scary, especially when you consider Reglan was discussed as a potential therapy when my infant daughter was suspected to have delayed gastric emptying (so one would hope it isn’t all that toxic to babies).

But we’re talking about selectively consuming these drugs in order to do something which is often marketed to women as the “natural” choice, the “biological norm”. If a woman wants to breastfeed, I would totally understand her desire to try these drugs, and more power to her. If a woman feels like she has to breastfeed, and has to take these medications in order to fulfill her biological and maternal responsibilities, that’s another story. And regardless, let’s stop the hypocrisy and ignorance so prevalent in the way we view and discuss breastmilk. If it is full of chemicals, the answer is obviously not to discourage breastfeeding, but shouldn’t it also be obvious that we can’t ignore the problem? Likewise, if someone has to take medication in order to breastfeed, we need to support her in her goals in whatever way we can, but we also need to ensure that she has adequate research on her side that proves she is not putting herself or her baby at risk.

Breastmilk, left to its own devices, is one of the most amazing and purest foods in the universe. Unfortunately, we live in a time when pretty much nothing has been left to its own devices. Nobody is saying that breastfeeding isn’t worth it, but in the world we currently inhabit, I don’t think we should view breastmilk as unadulterated, absolute perfection. It can be corrupted, like any biological substance.

So, FFF Sarah’s husband… I’m not sure what the answer to your question is, exactly. But I can tell you that while writing this, this image kept running through my head of one of those “Not treated with rBST!” messages stamped on a nursing bra. Thanks for that, buddy.

Medications and breastmilk – finding the truth behind the propaganda

I’m a little surprised that I haven’t see this story circulating around the blogosphere, but it has remained conspicuously absent from my Twitter feed and blog reader: Californian mother Maggie Jean Wortmon is being charged with second degree murder after her 6-week-old son died, supposedly from ingesting her methamphetamine-laced breastmilk.

Reading the comment threads on articles about this case has been enlightening. ” …If you don’t know that anything you consume while breastfeeding is passed on to your child via breast milk, you are too stupid to have a child. especially as it would be impossible for you to go through the process of childbirth and release from the hospital without being told at least five times that anything you consume is passed on to your child via breast milk,” one person said. “Its common knowledge that while nursing, what goes in, goes out in your milk, and to the baby,” said another.

But is it common knowledge?

According to the popular and respected site BreastfeedingBasics.com:

As a nursing mother, you should be aware that there are three things we know for sure about drugs and breastmilk:

1. Nearly all drugs pass into human milk.

2. Almost all medication appears in very small amounts, usually less than 1% of the maternal dose.

3.Very few drugs are contraindicated for nursing mothers.

    The site does explain that drugs are metabolized in different ways, and that the younger/smaller an infant is, the more he or she might be affected by the drugs. But the message that rings the loudest is this:

    “We…live in a society, which, in general, doesn’t place a high value on breastfeeding… Doctors tend to err on the side of caution and recommend that a mother wean rather that do research and reassure the mother that the medication is safe for her baby (as the majority of drugs are), or explore alternative, safer medications…..Most of the time, their primary source of drug information is the famous PDR…The PDR is not the best source of breastfeeding information, because it is an unfortunate fact that pharmaceutical manufacturers often discourage breastfeeding solely for fear of litigation, rather than for well-founded pharmacologic reasons…In deciding which drug to take, you should always look at the situation from a risk/benefit perspective: The benefits of breastfeeding are well known and undisputed, so doctors should recommend a mother wean only when there is scientific documentation that a drug will be harmful to her infant. In the rare cases where that is proven, a doctor who believes in the value of breastfeeding should take the time to explore alternative therapies, or if nursing must be interrupted, encourage the mother to continue pumping her milk to maintain her supply and return to breastfeeding as soon as possible. If your doctor prescribes a drug which he says in incompatible with breastfeeding, it is reasonable to ask for documentation and/or alternative medications. If your doctor isn’t flexible about this, and doesn’t understand how important continuing to breastfeed is to you, it makes sense to seek another opinion.”

    Now, obviously, BreastfeedingBasics is assuming their target audience is a woman debating whether she should take a prescription muscle relaxant after back surgery, not your run-of-the-mill, 6-week-postpartum meth addict. But there is a pervading belief in the breastfeeding community that the benefits of breastmilk far outweigh the “unproven” negatives of nursing while using medications, tobacco, or alcohol. If I were the meth-mom’s lawyer, I’d look to the breastfeeding literature as my best defense.

    Addicts are not counseled to bottle feed, but to breastfeed, even if their habit is far from kicked. “Breast milk contains small quantities of methadone, but the advantages of breastfeeding outweigh any possible negatives of passing very small amounts of methadone to the baby through breast milk,” states one site directed towards pregnant heroine addicts. An article written by an Australian IBCLC cites evidence of a plethora of substances – alcohol, nicotine, meth, marijuana, and more – coming through breastmilk in significant amounts, but then urges care providers to push breastfeeding at all costs:

    “Babies born to mothers who abuse drugs start life with a handicap. Their compromised intra-uterine life has affected their nutritional status, their growth and in some cases their intellectual ability. After birth they go through withdrawal symptoms that affect their health and adaptation to extra-uterine life…Artificial baby milk provides second grade nutrition, no protection against infections, has the potential to cause chronic disease and further inhibits the intellectual potential of the infant. Breastmilk is medicine for these babies and breastfeeding is about more than merely providing nutrition. Breastfeeding develops a bond between mother and baby, which may empower and motivate positive change on the part of drug-abusing parents, while decreasing the risk of future child maltreatment. This should be considered along with concerns about the likelihood or degree of drug exposure the baby has if breastfed….Giving birth and then breastfeeding can be an empowering and life changing experience for a woman and may be the catalyst that causes her to stop her substance abuse. Before counselling a woman to feed artificial baby milk, consider giving her the opportunity to meet this challenge.”

    Yeah, that worked out real well for Wortmon.

    To be fair, as many of these sites point out, depending on a meth addict to properly mix and serve formula is not the most reassuring state of affairs, either. But if we’re talking about a woman too high to feed her infant responsibly, we should probably be getting Child Protective Services involved. It’s almost an entirely separate discussion than the issue of breastfeeding and medications. Personally, I am more concerned with this potentially harmful meme that it is “common knowledge” that substances pass through breastmilk, with such conflicting messages out there.

    Obviously, if a woman believes that formula is poison, and that it will harm her child, the “possible” risks of drug-infused breastmilk pale in comparison. If care providers are explaining the risk-benefit analysis in this way, who could blame a mom for choosing breastfeeding, even if she is taking a contraindicated substance?

    It’s time we told women the truth. If nicotine passes through breastmilk, we have a right to know. If more than few glasses of wine is going to do more than make a baby a little sleepy, we have a right to know. If we’re addicted to cocaine and someone is telling us to try breastfeeding, because it will help us break the addiction, we have a right to know what might happen if we accidentally “slip up”.

    We have a right to know that formula is not poison, that children will grow well and thrive and be fine no matter if we feed them Enfamil or Similac or Earth’s Best or the Sam’s Club brand. We have a right to know exactly what the studies say about the differences between breastfed kids and formula fed kids, and what the real world meaning of these studies actually is, so that we can make an informed decision on which risks we’re willing to take. (I’d choose the possibility of a few more ear infections a year over potentially overdosing my newborn due to a medication which hasn’t been proven safe, but that’s just me.)

    As for Maggie Jean Wortmon…well, as one astute comment on the ABC version of this story suggested, “Breastfeeding is so pushed on Mothers and if she was off her face, she probably just thought she was doing the right thing.”

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