As National Breastfeeding Month continues, its celebration offers lots of reasons to celebrate breastfeeding, review the most recent studies on lactation, and provides an annual opportunity for childbirth educators and other birth professionals to review and revise their breastfeeding curriculum and teaching activities to be sure they are sharing the most current and relevant information. I know in my state of Washington, I have added information in my breastfeeding curriculum about marijuana use and breastfeeding since recreational marijuana is now legal for adults 21 and over. (Look for a future post on this topic.)

At the same time, I want to share one of my favorite stories that goes way back in my childbirth education career. While I have mentioned this before, I think August is a great time to bring it up again.

Many years ago, I worked for a major medical center in my community, as a childbirth educator, (I now teach independent classes) and my responsibilities included teaching a 2 1/2 hour breastfeeding class. This class, offered as part of a group package with other classes or available as a stand alone class, was well attended by both expectant parents and usually their partners too.

I covered the usual topics, that I suspect pretty much any other breastfeeding instructor might hit upon, cramming a ton of information into the time allotted in the most interactive way possible. We talked about breast anatomy, how the breast makes milk, latch, positioning, feeding cues and needs of the newborn, potential problems, benefits, fears, when to reach out for additional support and specific resources in our community and so much more. Pumping, returning to work strategies and introducing a bottle were also covered. I recall sharing the preferred food for a newborn is its own mother's milk at the breast, pumped mother's milk, donor human milk and then artificial milk (formula) in that order. I explained that there are lots of ways to feed a newborn and I trust that each parent will find the way that works best for them and their baby. I also shared that breastfeeding goes smoothly for some and offers more challenges to others, but there is lots of help and resources available.

Class evaluations were handed out at the end, and for years, I enjoyed the positive feedback and enthusiasm from the attendees, who stated time and time again that the class was fun, engaging and helpful, they felt more confident and should things be difficult, they knew they had resources for help. And then it happened. After years of teaching and hundreds and hundreds of students, I received an evaluation that struck me to the core. One that I still think about every time I teach breastfeeding classes or work with a birth doula client when I help them and their newborn to get breastfeeding off to the right start. In blue pen, exclamation point included..."Instructor has a clear bias toward breastfeeding!"

I felt like the air had been sucked out of the room. Left on the back table, in a pile of other evaluations, with no name or contact information. No way to follow up with someone who I clearly failed to connect with. Did I have a bias towards breastfeeding? It *was* a breastfeeding class. The objectives, as provided by the medical center had been met, but clearly, that night, I had not met a student's personal expectations. I felt horrible. And I still do, to this day.

What were the expectations of this expectant parent from the breastfeeding class they signed up for? What pressures were they facing, possibly from me, from others, from themself, that maybe I did not address? What fears or concerns did they (or their partner) have that I was not able to assuage? Did I "overpromote" breastfeeding? Breastfeeding is the biological norm for all mammals. It was a class to learn about breastfeeding a newborn. I went over every word I spoke that night in my mind, wondering if I crossed a line, even an invisible one that only this parent was aware of. Upon reflection, yes, I suppose I do have a bias towards breastfeeding. How could I not?

When I read all about the "parent wars" and people feeling judged for their infant feeding choices (breastfeeding, formula feeding, bottle feeding, donor milk, extended nursing, tandem nursing and so much more), I worry that parents no longer feel safe to make a decision that feels good for them, without inciting someone else's need to be judgemental of their choices. How can birth professionals support the biologic norm while meeting new parents where they are at? Providing support but not creating additional pressure. Setting families up for success, but be ready to help them when the road is bumpy and even at times unsuccessful or no longer possible. How can we leave people feeling stronger after their breastfeeding experience, no matter how it goes down? How can we stand together with these new parents, acknowledging what is best for babies, recognizing that all parents inherently want to do their best and for reasons, sometimes within the parent's control and sometimes outside their control, things do not go as planned. Just like birth.

We must not leave parents feeling less than whole. For if we do, we do not create parents who are well equipped to parent. We should stand united, supporting each other, teaching each other, letting children and young adults observe breastfeeding, talking about it to our peers, and co-workers and community. If I remember correctly, I never saw a baby breastfeeding, where I could observe closely, before I had my own children. I do not recall conversations with breastfeeding mothers, before I became an expectant parent, and we discussed breastfeeding in my childbirth class. We should not tolerate the sensationalistic articles published by attention grabbing media or be sucked in to their "feeding" frenzy, (pun intended) pitting one parent against another, forcing everyone to take sides.

I want to own that I do have a clear bias toward breastfeeding, but I want to support all families. Those that choose to breastfeed and those that don't. Or can't. I want to offer classes that are open and unbiased, provide accurate information and make myself accessible to all new parents, who seek support, resources or just a listening ear and strong shoulder. I want a re-do with that parent in my class, so many years ago. I carry this unknown student's comment with me in every breastfeeding interaction I have. I also remember the wise words of my friend, colleague, mentor and hero, Penny Simkin; "She has good reason for feeling this way, behaving this way, believing these things, and saying these things. I just may not know what those reasons are."

Please share with me, your thoughts on my experience. About your own "bias toward breastfeeding" and how you handle that with your students, clients and patients. I welcome respectful discussion and comments as we all celebrate and support parents on their breastfeeding journey, whatever that looks like. - SM

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