Giving Ourselves Permission to Rest\

(Around the time I gave birth to my second child, in 2012, I was asked to help my hospital in Connecticut become “baby friendly.” The accreditation of “Baby Friendly” means achieving 10 specific steps at a hospital: babies “room in” with their mothers and are not sent to a separate nursery, so they are available to breastfeed on demand. The Baby Friendly hospital also places a priority on mothers learning to breastfeed, especially on-demand and responsive breastfeeding, having trained staff, having a written breastfeeding policy, facilitating skin-to-skin contact, not providing supplemental formula, and providing ongoing support for breastfeeding after hospital discharge. Needless to say, it’s an involved process that takes a lot of buy-in from staff to achieve.

This hospital had previously failed this accreditation several times, mostly because they left out important stakeholders. The hospital had asked its two lactation consultants on staff to lead the accreditation process but did not involve other important people (ie, physicians, pediatricians, ob-gyns). This threw a wrench into the appropriate workflow, while also offending those physicians. As the newbie on faculty, they handed it to me and said, “Here! You make this happen!”

As I’ve written about before, I went through breastfeeding struggles with my first child. But, by the time I had given birth again in 2012, I had regained my confidence. My daughter and I were doing well together with breastfeeding and I felt like I could really speak to this ordeal, both as a physician and as a breastfeeding mother.

I was especially tired of hearing the people who had taught me, both in medical school and as my own physicians while I was nursing my baby, telling me that they knew what was best for me. From their years of experience, they knew what women wanted most. These people happened to be older, male physicians. (Yes, there is a pattern here). I was very offended by this kind of approach, which to me seemed condescending. How dare you tell me what I want or don’t want? I’m a highly educated, hard working woman. I’ll decide what’s best for me and my baby.

In order to help the accreditation process, and to educate some of these older male physicians at my new hospital, I gave a grand rounds presentation. My message was “You’re not really listening to us.” I developed and used my “Breastfeeding is like riding a bike” analogy (see The Bike Riding Analogy blog post) to great effect.

Maybe it’s not Either/Or

Cut to now. I work at a hospital that is not Baby Friendly, which I feel “some kind of way” about at times. The longer I’ve worked here, though, the more I realize that some women come here specifically because it’s not Baby Friendly. And moms are recovering better. And it makes me wonder if our breastfeeding rates are consequently better here.

At a birthing center, moms typically have short, natural labors (are not induced), deliver vaginally and without drugs, and no complications. And rooming in for a baby with a mom in that situation does work better for breastfeeding.

However. There are so many factors and situations affecting breastfeeding rates in a hospital. First, the national rate for c-sections across the country’s hospitals is around 30%; at some hospitals that rate is more like 40%. The c-section rate frequently correlates with the health of the women who are delivering. There are many different medical comorbidities that can cause a woman’s milk to come in late.

So maybe the fact that the older male physicians were always encouraging me, and their patients along with me, to be gentler with themselves, to give themselves a break on breastfeeding, makes a little bit of sense. I wonder more critically about this now.

But my bigger question, and it always seems to circle back to this, is “Why can’t we as women give ourselves permission to do what we need to heal our bodies? We are EXHAUSTED. WE JUST GAVE BIRTH! Sometimes in very traumatizing and physically invasive ways.

When will we, American women as a culture, allow ourselves to take a break? Why won’t we give ourselves that permission?