Mommy,What's That Baby Doing?

I am the second oldest of eight children and a normal part of life was my mother breastfeeding my younger siblings. It was done discretely but not hidden. I never remember anyone questioning, criticizing, or negatively commenting on breastfeeding. It seemed like mostly everyone breastfed their infants in my young world. It was normal and easily recognized.

A picture says a 1000 words. I have a beautiful large framed picture of a mother breastfeeding her infant in one of my examination rooms. It has been there for many years and the image never gets old, the brand does not change. It is seen by dozens of patients a day. The patients are male, female, young, and old, those who breastfed and those who did not. I regularly see patients looking at the framed photograph and wonder what is going through their minds. I have heard comments such as “That's a beautiful picture” and “Thank you for supporting breastfeeding.” Some patients, seeing the picture, will comment on their breastfeeding experience both good and not so successful and tell me their stories. When I provided maternity care, it was an advertisement for my support of breastfeeding to the pregnant mothers and other family members who came to my office.

One comment stands out as troubling and speaks volumes of where we are today with the normalcy of breastfeeding. One day, a curious 5-year-old was sitting on the examination table and intently looking at the picture. As inquisitive children do, asked a very honest question: “Mommy, what's that baby doing?.” I waited in anticipation for the answer from the mother, who did not breastfeed. She replied that the baby was feeding and then quickly changed the subject.

It is sad that a question like that would come from a child. If that were a picture of a baby drinking from a bottle of formula, would the question and response be the same? Unfortunately, I think the comments would be similar, remarking on the beautiful baby and mother. However, growing up in a formula-fed environment, the child would likely not have asked the question. It is rare that a child would not sit in a car seat or think that smoking is normal. Increasing vegetables in our diet and need for exercise are widely accepted as normal. However, many have not included breastfeeding as a normal part of growing up and sadly this includes some medical professionals.

A few years ago, I was asked by our high school staff to review a textbook for their health education class. Of course, I immediately looked up breastfeeding in the index and found only two references. It advised that one should not breastfeed if you have HIV disease or if you smoke. There were many other excellent pages on childhood nutrition but nothing positive on breastfeeding as part of normal infant feeding. We should also be concerned about what is taught about breastfeeding in our education system.

Our patients, whether we know it or not, count on us for correct facts and recommendations for their health. They count on us to provide physical and emotional support for their decision to breastfeed. We know that children develop opinions at early ages and those images are formed by their parents, family, community, and even their physicians. Advertising, store shelves, and community activities are abundant with images of formula feeding. However, this is not just a child issue. The relationships we develop with parents, grandparents, families, and our communities are a powerful tool we can use to educate the public to support parents and breastfeeding.

We have seen a lot of activity worldwide with the Baby-Friendly Hospital Initiative over the years. Support, education, and positive images of breastfeeding are becoming more abundant in our hospitals, but I suspect not so much in our offices. Our primary care offices should not only become breastfeeding friendly but also develop an attitude of being breastfeeding centered. To change the culture, we need to avoid complacency on the topic of breastfeeding. Displaying pictures and providing readily available breastfeeding images in our offices are a form of formula counter-advertising that can help form opinions of patients of all ages. The ABM protocol no. 19, “Breastfeeding Promotion in the Prenatal Setting” is an excellent place to start. ¹ Even if not providing prenatal care, I encourage our ABM members to read it, give it to their office staff and colleagues, and apply its recommendations.

Our goal for children seeing a picture or even a public display of breastfeeding should be to make an educated statement, “Mommy, that baby is breastfeeding too!”