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1999 LLLI Conference Sessions:
Promoting Breastfeeding or Promoting Guilt?

By Robin Slaw
Franklin NJ USA
From: NEW BEGINNINGS, Vol. 16 No. 5, September-October 1999, p. 171

Guilt. It's a feeling most mothers are familiar with. In the US, doctors are afraid to make mothers feel guilty about choosing not to breastfeed. There is even a popular book about avoiding guilt for choosing to bottle-feed either from birth or after failing at breastfeeding. Katherine Dettwyler, PhD, offered a thought-provoking look at guilt and the choices parents make. She suggested that we need to help mothers make informed choices based on full knowledge of the consequences of not breastfeeding.

Dettwyler pointed out that health care providers and others aren't afraid to use guilt for other parental choices. A pregnant woman who chooses to continue smoking during pregnancy can expect to be reminded of the health risks to her unborn child at every prenatal visit. Doctors have no hesitation whatsoever about making parents feel guilty about not using a car seat. Public advertising campaigns about auto safety often rely on creating guilt in parents. Many hospitals won't even release newborns to parents without a car seat in their car. Society views the choice to smoke or not use a car seat as below the accepted standard of childcare, so parents who make those choices are expected to feel guilty.

By contrast, breastfeeding is often treated as a choice that is above the normal standard of childcare-like buying expensive educational toys or sending a child to an exclusive private school. Breastfeeding books and articles talk about improving intelligence, improving health, or improving ways of life by breastfeeding. But Dettwyler suggested that using artificial baby milk could, and maybe should, be considered reckless endangerment because it increases risks to a baby's life and health, just like parental smoking and failure to use a car seat. What makes breastfeeding so different, that health care providers are reluctant to cause feelings of guilt in parents? For one, they don't know or don't accept the research documenting the harm caused by artificial baby milk. The media plays a dramatic role in portraying breastfeeding as painful or impossible for most modern women.

And many health care providers did not choose breastfeeding for their own children, so by denying that their choice had significant consequences, they are protecting themselves from guilt.

Dettwyler also talked about the difference between guilt and regret. Guilt is what you feel when you knowingly choose a lesser option for your baby. Regret is what you feel when the choices, and the consequences of your choices, are not explained to you. When many of us were growing up, we didn't use car seats or seatbelts regularly; they weren't even available in many vehicles. So should our parents feel guilty because they didn't require us to wear seatbelts? No, of course not. The research wasn't available then on how seatbelts save lives.

Dettwyler used her own life to illustrate. She has a son with Down Syndrome and she regrets not breastfeeding him longer. Uninformed health care providers did not consider that a few extra IQ points might make a dramatic difference for her son and encouraged her to switch to formula and bottles early. She said she feels sad about what happened, but has no cause to feel guilt, because she followed the medical advice she received.

Dettwyler had many suggestions for changing the way the choice to breastfeed is perceived.

  • Provide clear, accurate and complete information about the very real risks associated with not breastfeeding. The December 1997 statement on breastfeeding from the American Academy of Pediatrics (available from LLLI, No. 288-17, $2.50) is a good source for this information.
  • Work for hospital policies that promote breastfeeding such as the Baby Friendly Hospital Initiative.
  • Don't rely on information sources that make money when breastfeeding fails or is not chosen, such as pamphlets printed by manufacturers of infant formula.
  • Once we have made sure a woman has acquired complete information about the risks inherent in choosing not to breastfeed, then we need to respect her feeding decision.

I walked away from Kathy Dettwyler's session energized about breastfeeding. She helped me realize how important it is to share our stories, our knowledge, and our belief in breastfeeding with everyone. We can make a difference in the lives of mothers and babies, by helping mothers understand the very real differences between breastfeeding and bottle-feeding. And we can do this without worrying about causing guilty feelings in parents.

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