As Muslims and health care providers, the question of whether or not breastfeeding is the ideal form of infant nutrition is no mystery. We learn through numerous references in the Quran that extending this relationship to two years provides the most benefits to mother, child, and by extension, society, as is the recommendation by the World Health Organization. Why is it, then, that only 27% of babies are reported to be breastfed at 1 year of age (CDC Breastfeeding Report Card, 2013). More than simply promoting breastfeeding amongst new families, providers need the tools necessary to properly support them to ensure better success. Close examination of a typical breastfeeding experience illustrates the importance of this claim.
During her pregnancy, a new mother is advised to breastfeed and is given pamphlets on the topic. At birth, her baby is placed on her chest. She is applauded as her newborn latches and suckles at her breast, after which she will likely receive little to no breastfeeding supervision or guidance. In societies, where breastfeeding is the norm and has been for centuries, the mother is welcomed home, surrounded by mothers, sisters, aunts, and friends, to guide her as she and her baby perfect the art of breastfeeding. However, in the U.S., where newborn breastfeeding rates drop from 75% to 37.7% between birth and the third month of life, we can not rely on the hope of her receiving such support (CDC, 2013).
Mother and baby, however, are not to blame for failing at breastfeeding – rather, it is the medical system that has failed them.
What happens instead is that the mother, whose baby is incorrectly latched, begins dreading the pain she will feel with each feeding. Hesitant to ask for help out of fear of criticism, she bears it and continues on. Meanwhile, due to the improper placement of lips, tongue, and gums, the baby struggles to receive adequate milk, and either fusses in protest or falls asleep immediately at breast. Attention is finally given to the dyad when her nipples begin to crack and bleed, and the now jaundiced baby loses more than the acceptable 10% drop from birth weight.
Mother is then handed a 2 oz. sample bottle of formula, which the baby drinks in less than 5 minutes, despite the fact that a newborn’s stomach is only large enough to take in the 5-10ml of colostrum intended by nature in the first few days of life. The baby drifts off to sleep, spending the next 3 hours digesting the artificial breastmilk. Each subsequent bottle received places her at greater risk of inadequate milk production as her body lacks the frequent stimulation in the form of suckling required to boost levels of the milk-producing hormone, prolactin. Her confidence in breastfeeding plummets as the baby begins to prefer the ease of the fast flowing, corn-syrup sweetened formula, losing interest in feeding at the breast. The mother finds herself giving more bottles, and she is grateful to find a case of formula samples at her doorstep on week 2 postpartum. At this point, the dyad joins the majority of other mothers across the country who give up on nursing their babies, placing them at an increased risk of ear infections, GI- related illnesses, allergies, asthma, eczema, obesity, diabetes, and cardiovascular disease; the mother will now have a higher risk of breast and ovarian cancer. Mother and baby, however, are not to blame for failing at breastfeeding – rather, it is the medical system that has failed them.
In retrospect, the mother could have been taught to hand express her milk until she could receive a pump, now covered by health insurance through the Affordable Care Act, and thanks to Michelle Obama. If instructed to express her milk at least 10 times per 24 hours and advised to feed her baby her milk, and referred to a certified lactation consultant (IBCLC) or to community-based support such as Women, Infants, Children (WIC), perhaps she would have continued to breastfeed successfully. So let us continue to promote the best form of nutrition for our youngest patients while arming ourselves with the knowledge and resources to ensure that they make it through the most precious first two years of life.