Publisher’s note: Jessica Calarco is an associate professor of sociology at Indiana University. She is the author of “Qualitative Literacy”, “A Field Guide to Grad School” Y “Negotiating Opportunities”. follow her on Twitter. The opinions expressed in this article belong solely to the author.
(CNN) — When her daughter was born, one mother, whom I’ll call Dana, couldn’t afford to take more than two weeks off work. Dana was a school bus driver earning about $18,000 a year, and she was also the breadwinner for her family…but her employer didn’t give her any paid maternity leave. I met Dana in 2018 when my research team and I were recruiting pregnant patients at prenatal clinics in Indiana for a study on parenting plans.
Dana initially hoped to breastfeed her daughter for more than a year, but returning to work made that goal difficult and often painful to achieve. To work her bus shift, Dana had to get up before 5 a.m. while her daughter was still sleeping, and by the time she got home in the morning, she felt like her breasts were bursting point
“I would get so full,” recalls Dana, “I would come home and immediately have to breastfeed.” However, by this time of the morning, Dana’s husband had already put his daughter to bed for a nap. So Dana would let her 2-year-old son nurse for a while to take the pressure off, and then pump extra milk for her husband to give to the baby when he went back to work his second shift at the house. afternoon.
That combination of nursing and pumping, meanwhile, made Dana’s breasts produce more milk, which meant they’d be even fuller and more sore by the time she got home in the afternoon. This, in turn, aggravated Dana’s postpartum depression.
Given his low income, he might have been entitled to benefits from the Special Supplemental Nutrition Program for Women, Infants and Children (WIC), which covers formula milk for newborn babies. But, as Dana explained, “I felt like I didn’t deserve to be on WIC because I was sleeping in bed with the baby,” a sleep pattern that the WIC discouraged.
The American Academy of Pediatrics (AAP) recognizes that parents like Dana face “structural barriers to breastfeeding” and to fulfilling their new guidelineswho recommend that parents breastfeed or “breast feed” (a term that includes gender-diverse families) their babies exclusively for the first six months of life, and continue to do so along with other feeding options until two years of age.
Addressing employers, policymakers and health professionals, the new guidelines note that: “Policies that protect breastfeeding, including universally paid maternity leave; women’s right to breastfeed in public; insurance coverage for lactation support and breast pumps childcare in the workplace universal break time in the workplace with a clean and private place to express milk the right to feed expressed milk; and the right to breastfeed in child care centers and lactation rooms in schools are essential to support families in maintaining breastfeeding.”
Addressing these structural barriers to breastfeeding would help nursing moms like Dana. However, given what my team and I found in our research, I would also say that the AAP’s recommendations to employers, policymakers, and health care professionals do not go far enough to call for support for those who want breastfeeding their children, or to offer peace of mind to parents struggling to meet AAP goals.
An employer can follow the recommendations, and it still would not be enough
The AAP guidelines do not they defy the rules enough of workers based on white males with stay-at-home partners, standards that require female workers to sacrifice their bodies and their relationships with their families for the benefit of their employers.
To see what I mean here, let’s consider another mother, whom I’ll call Gina. As a lawyer who works long hours and earns $70,000 a year, she was able to take three months of paid leave after her daughter was born, and she was able to breastfeed almost exclusively during that time. However, when Gina returned to the office, she had a hard time finding time to pump in the midst of all her work demands.
“I have my own office with a door… I have a sympathetic boss… It’s an ideal situation in a way, but it’s still very difficult to find time,” he explains. “I have to leave this meeting now because I have to go do this. That has been unexpectedly hard.”
Gina also felt pressured to do something productive while she was pumping. As she explained, “I can’t take thirty minutes three times a day and not do any work during that time and then still come home at a decent hour.”
According to AAP guidelines, Gina’s employer did everything right; however, despite her initial plans to exclusively breastfeed for at least nine months, Gina ended up supplementing with formula and stopping breastfeeding altogether at six months.
Universal health care as an essential part of breastfeeding support
While some women have no problem breastfeeding without the guidance of a health professional, many others have difficulty. The AAP should advocate for universal health care, including breastfeeding support, as it would help these mothers find a way to feed their newborns.
To do this, let’s take the experience of another mother whom I will call Erin. When her first child was born, she was working minimum wage at a grocery store, had no access to employer-provided health insurance, and couldn’t afford to buy it on her own. Erin tried to use healthcare as sparingly as possible, but that became a problem when her son had trouble latching on properly while breastfeeding. This meant that she had to spend hours a day nursing because her son was not eating enough. This left her with cracked and bleeding nipples.
Finally, a lactation consultant told Erin that her son needed a procedure to correct the “lingual anchor”, which is when the tissue that joins the tongue to the floor of the baby’s mouth is so short that it is difficult to get a good latch during breastfeeding. Erin took her son to a specialist, who told her the operation, without insurance, would cost $1,000, money Erin didn’t have. The specialist encouraged Erin to sign up for Medicaid, but by the time they had finished the paperwork and were able to do the operation, Erin’s milk had dried up.
The stigma of not breastfeeding
The AAP guidelines also do not emphasize that it is okay for mothers to choose not to breastfeed or breastfeed for personal reasons, such as past abuse or trauma, or for physical problems, such as inverted nipples, shallow latching, tongue ties, duct blockage, mastitis, painful congestion and lack of supply.
These are just some of the common problemsbut painful, that the mothers we interviewed described as leading them to stop breastfeeding or plan not to breastfeed their younger children after trying their older children.
Consider a mother, whom I will call Beverly, who chose not to breastfeed her two youngest children after struggling to breastfeed her oldest. As Beverly explained, “My milk supply never came… I was dry before I left the hospital and nothing came out, period.” The new AAP guidelines make almost no mention of the difficulties mothers like Beverly face, except to encourage one-third of mothers who experience mastitis to continue to breastfeed despite the pain. In doing so, the AAP may inadvertently contribute to the postpartum depression and anxiety faced by many mothers giving birth in the United States today.
Dana, Gina, Erin, and Beverly all experienced mental health issues after giving birth to their babies, and they all linked those issues, at least in part, to difficulties breastfeeding as planned. These women believed that to be good mothers, they had to breastfeed, and continue to breastfeed despite barriers and pain. When they struggled to achieve those goals, they experienced self-doubt and self-blame.
The AAP could prevent exacerbating these mental health problems by offering stronger recommendations to employers, legislators, and health professionals, and by giving confidence to parents who struggle to follow AAP standards.
Breastfeeding and breastfeeding can have some benefits for both babies and mothers. However, the AAP’s claims about the benefits of prolonged breastfeeding are based primarily on correlation tests. Existing research can only say that the types of families who are able to follow the AAP guidelines have better health outcomes, not that following those guidelines actually improves outcomes for families who currently fall short.
If the AAP’s true ultimate goal is to improve the health outcomes of infants and postpartum mothers, future guidelines should emphasize mothers: If breastfeeding or breastfeeding doesn’t work for you and your family, it’s not your fault and that’s fine.