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 known definitively in the field of lactation medicine. And I 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 the language of the pure call for the raining down of violence, threaten to return our enemy to the Stone Age, to destroy whole civilisations in one night. We live in a time when market forces are coopting not just democracies but health systems, driving high levels of overdiagnosis and overtreatment, and the same has been happening and is 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 or accessible (due to government failure to prioritise) and when the those attempting to support the woman are unable to help her resolve the problem.

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 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 eliminating any researcher that they think they can catch in a single-issue net which fails to understand big picture, complex systems realities. This accidentally 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 was not accepted by colleagues earlier on, and dangerous, since the very title of lactation medicine itself excludes families who are formula feeding, and the very structure of the lactation non-profits is used to exclude health professionals and researchers.

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 & lactation as evolutionary norm, but does not use breastfeeding & 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 creates tools to further the wellbeing of our own kind, including formula) and eschews simplistic 1950s concepts of evolutionary biology (it’s ‘natural’ to breastfeed, when breastfeeding is alike everything else human a fundamentally biolcutlural act, so that women struggle on in our industrialised and mechanisied and disembodied indsturial cultures).

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 also think that a multiplicity of affiliation is perfectly fine. I do ask you to 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 keep on going.

We all do our best to help families. We are all afraid of failing in various areas of 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 sometimes and care for each other as we care for our patients. Let’s 'hype other women', as Erin Gallagher says!

Possums and the new Lactation Fellowship 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 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 offer their own versions. I welcome this in (but I do consider acknowledging the influence of other women - other professionals - as a fundamental ethical act in this most highly gendered of fields.) This is what I aim to offer, with help of various teams, in Neuroprotective Developmental Care, or the Possums programs.

Recommended resources

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