In the spirit of World Breastfeeding Week, I want to highlight all we can about breastfeeding; why it’s great for you and your baby, some ways to make it easier, and how to manage common challenges. But one challenge that often gets ignored in the offices of doctors and lactation consultants is the issue revolving around the ethics of breastfeeding. That is, addressing uncomfortable questions like these: Are moms who choose not to breastfeed “bad”? Are babies who are denied breast milk missing out on their basic human right to nutrition tailored exactly for them? Should we not educate women “too much” about breastfeeding so they don’t feel pushed into it? If a mom is struggling with breastfeeding, should we just tell her it is OK to stop, so she doesn’t feel guilty? Ugh. These are all really uncomfortable questions, all of which I have considered at one point or another in my career as a doctor and lactation consultant. I can tell you that the answers aren’t straightforward. I know many doctors who avoid the topic of breastfeeding altogether because they were never trained in managing it, so they don’t want to tell their patients the wrong thing. That’s not right. I also know doctors whose first response to any nursing challenge is, “That’s OK, you can always switch to formula.” That is also not right. And lastly, I’ve known (fewer) doctors who have tried to support breastfeeding to the point that they can’t help their patient make the transition to formula when they’ve really needed to. This too is not right. When I think of the ethics of breastfeeding, I try to compare it to how I counsel patients about smoking. If a woman comes to see me in the office and she is a smoker, it is my duty as a doctor to tell her that smoking is harmful. I need to ask where she is in thinking about quitting, recommend that she stop smoking, provide helpful resources so she can be successful, and follow-up with her to see how she is doing. And while I do all of this, I need to be supportive and let her know that I’m not judging her. I would never ignore the topic of smoking because I don’t want my patient to feel bad about herself – and in my mind, this is how I rationalize why it is important to talk about breastfeeding. I shouldn’t ignore the topic of breastfeeding because it might be hard or my patient may worry that she can’t do it. I would never tell a patient who was trying to quit smoking, “Oh it’s OK, you can just smoke if it’s really too hard to stop.” No way! I’d let her know that I know she is really trying, congratulate her on what she’s already doing, and figure out how I can help her more. (Again, don’t interpret me as saying I am comparing formula to cigarettes. That’s not my point of this comparison, so let’s not lose sight of that and turn this into a war on formula discussion!) So: the ethics of breastfeeding. We as providers have an ethical obligation to give our patients information so that if they choose not to breastfeed, it is truly an informed decision and not one based on fear or misinformation. If after that has all been presented and a woman chooses to wean or not try to breastfeed, of course, she is not bad and still deserves caring support. Guilt does no one any favors here. And if a woman chooses to breastfeed and needs help, it is our ethical obligation to make sure she gets that, and we do not abandon her. We can’t tell her to breastfeed and then leave her in the dark once an issue arises. So are moms who choose not to breastfeed bad? No. But medical professionals who don’t educate pregnant and postpartum women about breastfeeding are doing harm and may play a role in making that woman feel bad about herself. Let’s not let that happen. Source
