A call for the ethical lactation medicine of the future

A new kind of lactation medicine is required: ethical, integrative, and in service of women’s and family mental health

I don’t know a lot of things but I do know how little is actually definitively known in the field of the clinical managment of breastfeeding and lactation problems. I also know that we live in times of great global destruction of the planetary environment in which we live and of which we are a part: the climate, the seas, the creatures, the insects, the great thermal currents, deforestation. We live in a time of war, where those who use a language of purity and righteousness call for the raining down of violence, threatening to return an enemy to the Stone Age or to destroy a whole civilisation in one night. We live in a time when market forces are co-opting not just democracies but health systems, driving high levels of overdiagnosis and overtreatment. This same problem of overdiagnosis and overtreatment has been worsening throughout my lifetime in the field of lactation medicine.

We live in a time when commercial milk formula has become, through experimentation on whole societies of infants - the same way the oral contraceptive pill was refined through experimentation on whole societies of women - yet another of our brilliant human tools, which in the West does not yield the same benefits as human milk but is actually good enough when there is no donor milk available (due to government failure to prioritise accessible donor human milk) and when those attempting to support the woman are unable to help her resolve breastfeeding problems.

Predatory marketing practices of commercial milk formula are not the reasons why women in high income countries use formula. Predatory marketing practices need to be curtailed. They occur in the context of predatory marketing practices of huge numbers of multinational companies. The latter that are destroying our environment and climate, and need to be curtailed, urgently. Formula companies pose a much tinier risk to the future of our children and of our world than the multinational fossil fuel businesses, for instance. Why don’t we just get on with bringing in the best possible research, best possible clinical translations, and best possible multi-domain care for breastfeeding or lactating women and their babies? Is this exclusion of researchers and clinician-researchers more about who holds power within lactation non-profits, rather than about the best interests of families?

Wwomen use formula because they face insurmountable breastfeeding and infant behaviour problems, which our lactation professionals are unable to help. Our lactation professionals are unable to help because instead of investing urgently in the research and education that would offer effective tools, they are obsessively and tragically focussed on silencing any researcher that they think they can catch in a single-issue net which fails to understand big picture, complex systems realities. This ideologically-driven approach harms breastfeeding women and their babies, because it results in unintended outcomes.

Lactation medicine is also trying to take over all fields of infant care, now claiming singular expertise in unsettled infant behaviour, infant sensory motor development, cry-fuss problems, and perinatal mental health. This is both remarkable, given how my work on breastfeeding-embedded approaches to unsettled infant behaviour were not accepted by breastfeeding medicine colleagues earlier on, and dangerous, since the very title of lactation medicine itself excludes families who are formula feeding.

What is required for the future of new humans on this planet in these extraordinary times is an evolutionarily aligned, complexity-based, holistic approach across multiple interacting domains of infant care, which is foundationally based upon breastfeeding and lactation as evolutionary norm, but does not use breastfeeding and lactation as a title because of all those families who would be excluded. It’s an approach that uses a wise and contemporary understanding of evolutionary biology (Homo sapiens has a genius for creating tools to further the wellbeing of our own kind, including formula) and eschews simplistic 1950s concepts of evolutionary biology (such as it’s ‘natural’ to breastfeed, when breastfeeding is like everything else human: a fundamentally biocultural act).

Let's support other women (not try to silence them)

That’s what I’ve been doing with NDC or the Possums programs all these years. I would never ask my colleagues to choose between Possums or BMNANZ, even though more than 74% of BMNANZ doctors have been upskilled in NDC – although I have the view that dissent and difficult conversations need to be invited in. I have the view that a multiplicity of affiliations is sensible, and enriching. I do ask anyone who’s thinking has been influenced by NDC to freely and openly acknowledge it, that’s all, in the hope that Possums might be able to continue making a contribution.

We all do our best to help families. Most of us, as professionals, are afraid of failing in various areas of our professional endeavour. We all deserve such tenderness and encouragement and celebration! Elements of our professional lives and professional organisations will have a messiness to them (conflict, struggle, imperfection) since being human is messy. But there should be room for all of us to blossom and lead sometimes and follow other times and care for each other as we care for our patients. Let’s 'hype other women', as the writer and social media influencer Erin Gallagher says!

My work offers a different way into caring for families with babies, which doesn’t exclude, or extract without acknowledgement, but which aims to celebrate and honour the tenderness and the courage of every other researcher's or educator's contribution. Possums offers a lactation medicine which serves the emotional and mental wellbeing of the mother and the family, which doesn't sacrifice a woman's emotional wellbeing and mental health - since her wellbeing and the family's wellbeing is fundamental to the wellbeing and development of the baby in the short and long-term.

I call for a different kind of lactation medicine, a lactation medicine that is ethical and genuinely integrative, that knows dissent is vital to scientific and clinical advances, that is holistic and embedded in the service of infant and family wellbeing. It’s likely that others will be passionate about offering their own versions. I welcome this - but I do consider acknowledging the influence of other women - other professionals - as a fundamental ethical act in this most highly gendered of fields, in this most unethical of times.

This is the ethical lactation medicine of the future, and it's what I aim to offer, with help of various others, in the Neuroprotective Developmental Care Lactation Fellowship.

Recommended resources

Possums Breastfeeding & Lactation articles which address lactation non-profits, ideology, and harm