Mothers are told all the time that the reason they are having trouble with breastfeeding is because their baby is lazy, or too greedy or naughty or is a little piranha. This REALLY burns me up for a variety of reasons, firstly because it is a sign of the speaker's ignorance and lack of skills to identify what is really going on with this baby (and that offends me as a midwife and a lactation consultant). Secondly, it makes me irate because it is untrue, and it often ignores REAL problems that can affect a baby's ability to feed and thrive and even survive (and this frightens me, because I have seen how major health problems can be missed as a result of this). Finally, because research shows that these kinds of labels can have a strong impact on a mother's view of her baby, on her sense of herself as a mother, and on her relationship with her baby, potentially forever, and this breaks my heart as a mother and as an advocate for mothers and babies.
How I know your baby isn't lazy, greedy, naughty, a little piranha or whatever other unhelpful things breastfeeding "helpers" have told you!
1. Mothers and babies are designed to breastfeed. Not only are human mothers and babies (and all mammals) born to breastfeed, but we come with instincts and hormones and reflexes all designed to ensure that a new baby gets fed its mother's milk. Although we humans have devised all kinds of ways to undermine and subvert these instincts and reflexes, and we even alter breastfeeding hormones with artificial hormones and other drugs given during labor, fundamentally our mammalian instincts to feed our baby are still very strong. And our babies come with a hard-wired drive to make it to the breast and to feed there. Their drive to survive is mighty, and surviving means nursing (they don't know about formula or artificial teats). No baby comes out "too lazy" to feed, and thus unable to survive unless there is something physically hampering his or her natural abilities. No baby is "greedy" and demanding more food than she or he needs, but they may be struggling to get enough milk for some reason. And no baby hurts his or her mother's nipples because of some character or personality flaw. Human babies are designed to feed and feed a lot, and if feeding isn't going well or is causing mother pain, it is because there is a real problem with the latch, with the position, with the anatomy and physiology of the baby's mouth, (or the mother's breast and/or nipple) and blaming a baby for being lazy or greedy or chompy isn't going to fix that problem.
2. A baby who seems "lazy" wants to breastfeed but can't. A baby who isn't latching and nursing well, or is falling asleep at the breast or is difficult to rouse, should be thoroughly examined for physical problems, and should never be brushed off as unwilling or unable to feed. Over the years I have seen many babies who struggled to nurse, for many different reasons. Some of them were written off by doctors, midwives, or nurses as just not wanting to nurse, or being too lazy. If I had a dirham for every mother who was told her baby was lazy, I'd be a wealthy lactation consultant! These are just some of the scariest cases I have seen:
Cleft palate. I was working in a hospital as a breastfeeding specialist midwife, and I came in after my weekend break to find a set of twin boys had been born 2-3 days before. One was nursing just fine, while the other was unable to nurse at all, and was even having a hard time with a bottle. "This one is lazy," the nurses/midwives told me, which immediately raised an alarm for me. Obviously mum had milk, if the other twin was doing great. And as I KNEW that babies are not lazy, I did a full exam to see if I could find anything. When I offered my gloved finger for baby to suck, so I could assess his mouth and sucking ability, my finger went through a hole in the roof of his mouth. "Nobody told me your baby had a cleft palate!" I said to the mother. She looked at me blankly, no idea what I was talking about, so I ran out to the nurse's station to ask there. Nobody had noticed that this 3 day-old baby had a hole in his soft palate, even though he had not been able to feed ever since he was born. The pediatrician who had "examined" this baby was bad enough to have missed this after birth, but the fact that everybody just accepted that he was too "lazy" to nurse was somehow even worse. He was not lazy, he was physically unable to create a vacuum in his mouth, which is necessary to maintain a latch and draw milk from the breast (and even from the bottle). He needed a special cleft palate feeding device until he could have surgery to correct the hole in his soft palate. Would they possibly have just sent him home undiagnosed, unable to feed and no plan in place?
Heart defect. I met another little twin who was sent home from the hospital not being able to nurse. She attended my baby massage class with her sister and her mother. This little girl was also deemed too lazy to breastfeed by medical people, but I suspected something else was going on and suggested a tongue tie assessment. It wasn't that, but she then got sent to an osteopath, and then to a pediatrician. One pediatrician after another just said, "she just can't nurse. She's too weak, or two lazy or two small, or whatever, she just can't nurse." Fortunately for this little girl her mama was expressing and giving her breastmilk, and her sister was helping to keep up mum's supply, but she even struggled with the bottle and was quite thin. Because mum now understand that ALL babies should be able to feed she was persistent and kept taking that baby to doctors until one finally heard a heart murmur and identified a heart defect that required surgery. She was not lazy, she was struggling to pump oxygenated blood around her body, leaving her too weak and easily exhausted to feed well. The doctor who finally identified the problem was amazed that the little girl had never had an illness, because most kids with this heart condition are ill all the time. Of course it was her mother's expressed breastmilk which had kept her so healthy, but she was still very thin and weak and needed the heart surgery for her long term ability to survive and thrive. Again, the missed heart murmur was bad enough, but the inability to breastfeed (or even bottle feed well) should have been a readily identifiable sign that all was not well. What would have happened to this baby if her mother had not been so persistent?
Tongue tie. I have met countless babies who struggle to breastfeed because of tongue tie. I met one mother with 4 children, none of whom had been able to breastfeed. She was told by a midwife (and I agreed) that her 4th baby had a very restrictive tongue tie, but her pediatrician told her tongue ties were a myth and all these crazy "western" lactation consultants were finding problems where they didn't exist. That mum also had a very tight tongue tie herself and she also had not been able to breastfeed as a baby. The doctor found it easier to accept that some families just can't breastfeed than to accept that a tight frenulum (which can be genetic) was making it too hard for babies in that family to feed effectively or with more than a couple days duration. How did we survive as a species if it was that common for young to be unable to feed?!?
This isn't by any means a definitive list of reasons why a baby may struggle to breastfeed--many, many different issues can cause feeding problems, too many to list here. If you have a baby who seems "lazy" at the breast, see a good lactation consultant to try to figure out what is going on. And if that lactation consultant is not able to figure it out, see someone else until you do figure it out. BABIES ARE NOT LAZY--they are designed to nurse, and if your baby can't nurse, you need to find out WHY!
3. Babies are not greedy, they know how much breastmilk they need. People will label a baby greedy for wanting to feed more often than the arbitrary 2-4 hourly schedule that someone has decided is optimal. Or they are called greedy for liking to stay at the breast for longer than some "expert" has decided to be "enough." They might be looking to breastfeed in perfectly normal patterns that just don't fit the book or the schedule that someone is trying to impose on them. They may also be going through a growth spurt and increasing their milk demand so as to increase the supply--not greedy, perfectly designed and super clever to manage their mother's milk supply to meet their increasing needs! In other cases a baby looks "greedy" because he or she always wants to be at the breast and never seems satisfied. This can be a baby who actually is NOT getting enough milk, either because latch is poor and milk is not flowing, or because mum's supply is low, or because of some of the physical problems discussed above. It can also be a baby who is asking to be at the breast for reasons above and beyond food--comfort, warmth, immunity, security, familiarity, etc. A baby is most physiologically stable when at its mother's breast, and breastfeeding provides so much more than just food.
With breastfeeding there is no "greedy," there is only getting enough milk or not getting enough milk, and being able to tell if baby is getting enough is absolutely essential (by watching nappy output, weight gain, and observing swallowing). You can underfeed a breastfed baby, but you really can't overfeed one. Feeding "on demand" or "on cue" will not result in a greedy baby, but should result in a thriving one. If baby is not thriving, then a qualified breastfeeding specialist needs to help you figure out why. As a new parent it can even be hard to tell if baby is getting enough, so in a perfect world every new baby would been seen by a breastfeeding specialist at least 2 or 3 times in the first 2 weeks of life to make sure feeding is going well.
4. Babies do not hurt their mothers on purpose. A new baby does not "know" how to breastfeed; a newborn is pure instinct and reflex. A baby mammal of any kind is born with all the reflexes and instincts he or she needs to get to the breast, find the nipple, latch, suckle and drink. If placed in the right position with the breast accessible, a new baby is designed to "know" what to do, but that knowing is not cognitive, it is pure instinct. A baby under 4 months can only manage to nurse if his or her reflexes are triggered and able to function as designed--after 4 months those reflexes go away and a baby who knows how to feed will do so from knowledge and experience. Before 4 months, a baby who is not positioned correctly, or who is somehow unable to follow those instinctive movements and reflexes will struggle, and may indeed cause mum pain, frustration and stress. But this is not a sign of a character flaw, nor naughtiness; this is a sign of a baby trying to do what she is designed to do and struggling. Chomping or clamping on the breast, chewing or pinching the nipple is all a sign of a bad latch, or a poor position, or of a physical issue that is causing baby to compensate in order to get milk.
The baby's "job" at the breast is to take in a deep mouthful of breast, with the nipple far back in the mouth (at the juncture of hard palate and soft palate) with the tongue curling up on the sides and forming a groove to cup the areola/breast tissue and make a teat. The baby's next job is to form a seal with her lips so that a vacuum, or negative pressure, builds up in the mouth. This negative pressure, along with the up and down movement of the back of her tongue as she suckles, will draw the milk from the breast so that she can swallow it. Baby then needs to coordinate suck, swallow and breath throughout the feed. If any of this doesn't work because of anatomical problems in the mouth, lack of muscle tone, or anything else, then pain can result for the mother and poor milk transfer for the baby. This is a problem that must be identified and fixed by a breastfeeding specialist--and is not a character flaw in a baby (nor a failure by the mother)!
5. The words "experts" use matter. When a struggling breastfeeding mother looks for help, some breastfeeding "helpers" will tell her that it is not her fault, rather that it is her baby's fault that she is struggling. They surely want to make the mother feel better, so that she does not blame herself. But to a new mother, blaming the baby IS blaming the mother, because mother/baby are one unit. There is no baby without mother. Better to point out to a new mother how her baby is trying so hard, how well designed her baby is to "know" how to feed, and then help the two of them overcome whatever struggles they are experiencing.
Research has shown that these thoughtless and inaccurate labels used by midwives, nurses, doctors and other breastfeeding helpers can have a huge impact on the mothers who hear them. We know that women during pregnancy, birth and after birth are incredibly sensitive and open to the judgment of others--part of this is a result of our high levels of oxytocin during this time. Oxytocin primes us to tune into our baby--to become more empathetic and connected. Oxytocin can also make us more vulnerable to cruelty, judgment and careless labels from "experts" whose opinions and assistance we are desperately relying on during this major life transition. Mothers remember the things that experts to say to them forever--these can be positive, empowering memories, or they can be hurtful, shameful and even traumatizing, depending on the words and tone used. Mothers also take cues from experts on how to think about their baby. Research showed that mothers who were told their babies were lazy, greedy or naughty later repeated these same assessments when talking about their own babies. These words can be taken seriously by a new mother and may alter her entire perspective on her new baby, thereby damaging their bond and their relationship (which is essential for a baby to thrive). Mothers also take on these judgments about her ability to be a good mother, so words of encouragement, positive feedback plus constructive advice that enhances a mother's ability to understand and empathize with her baby will actually increase her own long-term confidence as a mother, while any negative assessment of the baby or the mother can make mum feel as if she is a failure.
If the person who is trying to help you with breastfeeding is making you feel worse about your baby, yourself, or your ability to figure out mothering, then find someone else to help you! Not every person who holds themselves up as a breastfeeding helper is really trained or qualified to do so--in fact, we know that the less qualified or knowledgable someone is about something, the less likely they are to realize how little they know! We don't know what we don't know, and breastfeeding is actually a pretty complicated process when it isn't going well. Someone who doesn't really know what they are doing may end up blaming the baby, and this is a very strong hint to you that you need to look for someone else to help you!
In the end it's the doctors and midwives and nurses who need to read this, because in a perfect world nobody would ever label your baby as lazy, greedy, naughty or a "little piranha." A health care provider who isn't able to help you get breastfeeding working well would know to refer you to someone who could, ideally a qualified and experienced International Board Certified Lactation Consultant, with hundreds of hours of training and thousands of hours of experience behind her or him. But that isn't the case yet, and most doctors, midwives or nurses will just plunge ahead and give you advice based on their limited knowledge and training, believing that they know more than they actually do. Even with lactation consultants you may have come across one who isn't the right fit for you and your baby, so look for another one. And if you remember nothing else, remember that nobody who really understands breastfeeding will ever call your baby lazy, greedy, naughty or anything else that stupid!
What has your experience been with breastfeeding helpers? Did you feel well supported? Was the language used about your baby as thoughtless as this? Did you ever feel like your baby was being blamed for making breastfeeding so difficult? Did you ever discover a physical reason for it that was missed by a health care provider? We would love to hear from you about your experiences!
Amy Vogelaar is a former midwife, an International Board-Certified Lactation Consultant, a licensed BabyCalm and ToddlerCalm consultant, a Certified Infant Massage Instructor, co-founder of Love Parenting UAE, and a mother of 2 girls, each breastfed for over 2 years. She knows that there is still a LOT about breastfeeding that she doesn't know, and that is a good place to start from. Amy teaches Antenatal Breastfeeding workshops in Dubai, designed to help parents-to-be decipher all the confusing and conflicting (and sometimes inaccurate) advice they will receive about breastfeeding, get off to the best start possible, and find help when they need it.