Breastfeeding Guilt-Part III

A couple of months ago, I began writing about guilt and breastfeeding. Guilt is one of the more complex human emotions. It is particularly subjective; some people feel a great deal of it, others little or none. What makes one person feel guilt, another may shrug off, not even thinking guilt should be or could be attributed to the given situation.

Turning to Merriam-Webster, I learn that guilt, a noun, is a “feeling of culpability especially for imagined offenses or from a sense of inadequacy.”

I’ve heard some doctors, nurses and childbirth educators say they do not want to fully promote breastfeeding because women may in turn feel guilt. There is some sense to that.  What if I tell a mother she should breastfeed because her baby will have fewer ear infections, and she still chooses not to breastfeed? Will she feel culpable as she holds her shrieking, febrile infant at the pediatrician’s office? And won’t I then feel culpable for her feelings! Even worse, if she tries desperately to breastfeed but isn’t able to, and then ends up with the shrieking, febrile scenario, I will certainly feel awful if she is connecting the infection with a “sense of inadequacy” on her part.

This is an uncomfortable slippery slope I am tempted to avoid. Perhaps a more moderate take on breastfeeding would better serve all involved. We could change the message from “Breast is best” to “Breast is pretty good if you can and want to do it.” It’s not as catchy, but if we could avoid the guilt! We could then extend this same open-mindedness to smoking cessation, obesity and exercise. If health care providers take a more moderate stance, we could rid the world of guilty obsessions and self-condemnation. Right?

Or we can tell the truth. Breast is best. Babies are less likely to become obese, have diabetes, have GI infections and ear infections. They may even be smarter. Mothers are less likely to be overweight and have diabetes too. Women who breastfeed reduce their risk of some cancers. If we could encapsulate and bottle the benefits of breastfeeding, we would promote it, sell it, work two jobs to buy it ourselves and even endure some pain, if necessary, to be sure to have it.

And what if we tell the truth, and she still decides not to breastfeed, or worse, tries and fails? We will smile, support her and teach her what she needs to know for the path she is taking. We will not guilt her. If she assumes guilt, we will smile, support her and teach her how to move onward. We cannot predict who will feel guilt and to what extent. Therefore, any efforts to preclude guilt are likely to fall flat, acting as a disservice to everyone. Doctors, nurses and childbirth educators have a duty to offer the best information, leaving subsequent outcomes and unpredictable feelings to be dealt with in real time when, and if, necessary.

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Guilt-Part II

Some say worry is the work of motherhood. It begins the moment the stick shows two pink lines—Am I ready for this? Is everything ok? Will my baby be healthy? Is it a boy? A girl?

Will I be a good mother?

That’s the question that underlies all the others. If the baby isn’t healthy, we mothers immediately wonder if it’s our fault. What did I eat or not eat during the pregnancy? What supplement did I miss? Was it the bike ride … the boat ride … the vacation … the one glass of wine before I knew I was pregnant? After the baby is born, every angst our child suffers calls into question our mothering skills.

It’s called Mother Guilt.

For some women, after deciding not to breastfeed, repetitive information about the benefits of breastfeeding may tap her Mother Guilt defenses. After all, each time we (health care providers) are telling how good breastfeeding is, we’re telling the non-breastfeeding mother how much she is depriving her baby of those very benefits.

So what do we do to assuage the guilt?

Health care providers:

  1. Don’t water down the message! Doing so is a disservice to the majority who want to breastfeed.
  2. Ask women what information helped make their decision not to breastfeed.
  3. Actively listen, offering information and support.


  1. Remember, only YOU are equipped to make the best decision for you and your family.
  2. Breastfeeding is only one of many healthy choices parents make for the well-being of their children. Once you’ve made your informed decision, get on with the million other things you can do to have a healthy, well-adjusted child!
  3. Good parenting doesn’t begin and end with a feeding choice. It begins with love.

“Of all things love is the most potent.”—Maria Montessori

“Parents are often so busy with the physical rearing of children that they miss the glory of parenthood, just as the grandeur of the trees is lost when raking leaves.” –Marcelene Cox

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The question was asked of me again this week, “Amy, if we do all this to promote breastfeeding, won’t we make mothers feel guilty?” I’ve had a lot of conversations about breastfeeding and guilt, and I’ve come to the conclusion there are three facets to breastfeeding guilt:

  1. The mother who wants to breastfeed but it doesn’t work out the way she expects
  2.  The mother who does not want to breastfeed but feels pressure to do so anyway
  3. The health care provider who is afraid of imposing guilt on women by promoting breastfeeding

Let’s take just one each week, beginning with the mother for whom breastfeeding doesn’t work out. This is the gung-ho mom who reads the books, absorbs her doctors’ and nurses’ advice, plans to see a lactation consultant, takes the class and otherwise does everything possible to prepare for a successful breastfeeding experience. Good for her! And yet some people want to temper her enthusiasm with ominous messages about breastfeeding not being easy.

I appreciate their intentions—they want the mother to be prepared and realistic. However, sometimes these well-intentioned messages can undermine a woman’s resolve, making her question her abilities and determination. I’ve heard people say, “Just wait. Once your—fill in the blank—milk comes in, nipples get sore, baby cries, first night home—you’ll give a bottle too.” These same people say not to get a new mother’s hopes up. When these conversations come up, I always think of a friend telling another friend that she wants to run a marathon and is training for one in several months. A good friend always cheers a friend on!  All the more, health care providers have a duty to promote what is healthiest, providing an environment where breastfeeding is most likely to be successful and that features high-quality, consistent information.

Now I can hear people saying, “But what if your friend is sedentary, overweight and wants to run this marathon in 4 weeks? Isn’t the compassionate reaction to offer realism and support?” The truth is most women can breastfeed. Failure is more likely when women do not have the support they need.

I hear the same guilt argument for women who want a natural childbirth—“What if she can’t do it and feels guilty?” Well, if she can’t do it or changes her mind and doesn’t want to do it, we’ll all support her. If she feels guilty, we’ll help her through that too. This idea that we’re going to withhold enthusiastic support and promotion of a good thing “just in case” it doesn’t work, may set mothers up for the very thing we are afraid of—failure and guilt.

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All I Ever Need to Know I Learned From Breastfeeding?

We’ve all heard of the Robert Fulghum book All I Ever Need to Know I Learned in Kindergarten. I think it’s true—be nice, share, don’t pull on pigtails, tie your shoes—these are life lessons that never lose their value.

Those of you who follow BlogtoBabyFriendly may have noticed a decline in the number of posts, and if you work at my hospital, you probably already know the reason why. For the rest of you, let me fill you in. Last November I took the opportunity to be the manager of our labor and delivery unit. We call it the Childbirth Unit. After years of working in lactation and as a doula, I became a nurse at 34 years old with the very specific intentions not only to work as a labor and delivery nurse, but to work as a labor and delivery nurse at Memorial Hospital of South Bend.  How exciting to now be serving as manager for the nurses I have admired for so, so many years!

In my new role, I’ve been surprised at times how my background in lactation has benefited me in unexpected ways. Just like the kindergarten book, some lessons carry over to management and beyond. Here are just some examples:

  1. Support is a must have for success
    When I taught breastfeeding classes, I always told families the most important thing is to have a support system. I put it as No. 1 on my list of things to know and told classes it wasn’t No. 1 just to get it checked off our agenda, but because it really is the No. 1 thing needed to be successful. How many times have these words rung in my head lately!
  2. Pain can be normal
    It drives me crazy, the constant message that if a woman is doing everything right, she shouldn’t feel pain! Yes, it’s true, she should not have cracked, bleeding or excruciating pain, but as her body adjusts to something she has never done before or hasn’t done in a while, some tenderness is to be expected. This notion that you’re only doing something right if it comes with ease is one that sets us up for failure in any endeavor. Learning something new comes with hard work, a learning curve and sometimes even a little pain.
  3. Commitment to the big picture
    It’s easy to get mired in the 3 a.m. fatigue and wonder why on earth not to just give in and go with a bottle of formula. Then there is the pressure from people around you—grandma wanting to feed the baby, the friend who formula feeds and her baby is fine, your husband who would just like a little time with you to himself. It’s in these moments that keeping the “why” squarely in front is essential. In management this is called Values Based Leadership, and it has been my guide. All the pressures surrounding me are important, but my job is to keep the big picture always in the forefront—an exceptional birth experience in a safe environment for every family who allows us the privilege to care for them.

I love my new job and the challenges it brings me. Thanks blog followers for indulging me in a little reflection. True Baby-Friendly progress updates to follow soon! Exciting things are happening!!!

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Sleep Like a Baby

Baby-Friendly Step #7 “Practice rooming-in—allow mothers and infants to remain together 24 hours a day.”

My first baby was born in the days when husbands left the hospital at night and babies slept in the nursery. I remember our first night at home — it was terrifying! With no nurse to watch over our baby, we were afraid to sleep. We were unsure how to put the baby to bed or what to expect at night. My husband and I got very little sleep those first few nights home.

Traditionally, babies have been sent to the nursery for nursing care and to let the mother rest and recover from childbirth. However, we now understand the best people to care for their babies are mothers and families, under the nurturing guidance of nursing staff.  Mothers are able to sleep within arm’s reach of their sleeping infant. There, mothers and infants can learn each other’s sleep patterns and sounds, preparing them for their first nights at home together.

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Before and After

I love “before and after” pictures.  Anything before and after will grab my attention — weight loss, home improvements, makeovers — I just love it!

We are realizing some of our own “before and afters” at Memorial Childbirth Center as we are nearing Baby-Friendly designation. In the past, our nursery was full of babies.


Today, it is unusual to see babies in the nursery. In the past, breastfeeding was viewed by administration as merely a feeding choice. Today, exclusive breastfeeding is tracked daily as one of our Key Performance Indicators (KPI). In the past, skin-to-skin contact for moms and babies in the operating room immediately after cesarean birth was a far-fetched impossibility. Today, 88 percent of our babies and mothers have this opportunity.

afterAnother before and after is in our lactation department. In the past, we had an exceptional group of lactation consultants who did a great job helping mothers all over the hospital with their breastfeeding needs.  They also provided regular breastfeeding education for our Mother Baby Unit nurses.  Reading that, it hardly seems we needed an “after.”  But some changes were necessary, including:

  1. A Lactation Coordinator was designated, providing leadership and facilitating communication both within the group and with others in the hospital.
  2. Nine additional nurses received certification as lactation specialists (CLS).
  3. An existing breastfeeding support group program was expanded from one day a week to two.
  4. An educational booklet was created in collaboration with The St. Joseph County Breastfeeding Coalition to help communicate Baby-Friendly changes to pregnant women in our community, as well as care providers and doctors’ office staff.
  5. An interdisciplinary committee (The Mavens) was created to plan and implement breastfeeding education for nurses, patients, hospital units and doctors’ offices. So far, this group has created a brief computer-based learning (CBL) program required for all Memorial employees and has personally shared Baby-Friendly and lactation services information with several units in the hospital, including:
    • Pediatrics
    • Emergency Trauma Services
    • Radiology
    • Environmental Services
    • Lab
    • Nutritional Services
    • Ambulatory Care Center
    • Outpatient Surgery Center
    • Pre-admissions and Intra-operative

The work of Baby-Friendly right now is disseminating information to others, beginning within the hospital, and then our community. We realized helping women successfully breastfeed cannot be the work of five lactation consultants alone. It takes everyone working together, with our expert lactation consultants at the helm, to lead us to where we want to go.

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A Little Luv

I’m a sucker for a good advertising campaign, and I have to admit, when my kids were babies, “I got real and got Luvs.” After diapering child #1 in ultra brand name nappies, I was proud to be the mom who was past all the pretension of a newbie and grounded in the real world of parenting.

More than a decade later, Luvs continues the “get real” message, this time with a message of normalizing breastfeeding. Spread the word! Breastfeeding is normal, natural and necessary!

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