Here is the transcript of this video:
This past Thursday, January 5, 2012, we noticed that my daughter had a bit of a white patch on her mouth. After taking a look at it closely, I diagnosed it as being more than likely thrush and I called her pediatrician. My daughter’s pediatrician was not available that day but the nurse recommended that I go to the after care clinic and she gave me the name and telephone number of Dr. Andre Engels here in Ottawa. I called, made an appointment for that evening at 7:15pm and my husband and I brought our daughter there.
Dr. Engels seemed like a really nice doctor. He was sweet with Willow, looked at the photographs I had taken of her mouth and looked inside of her mouth and agreed with my diagnosis. Willow did indeed have thrush. He spent some time admiring my camera and telling me that it took great pictures while my husband got Willow ready to leave the office.
After Dr. Engels wrote the prescription for an anti-fungal medication for Willow, I began telling him how fortunate we were that in thirteen months of breastfeeding, this was the only issue we had experienced. Dr. Engels then looked at his chart and back to me and said (and I quote word for word), “So, is it true that you plan on breastfeeding her until she is in high school?” I was incredibly thrown by his comments and was unable to respond so, sensing the discomfort in the room I am sure, he turned to Steve and said, “Well, at least it is legal in Ontario.”
He left the room and Steve and I turned to each other but we could barely speak as I am pretty sure we were both in shock. You see, you expect judgment on certain parenting choices from friends, family, the general public, etc. but you never expect it from a pediatrician. I was stunned because I had assumed that the doctor would be pleased that we were able to breastfeed and that it had been so successful thus far. I was not expecting to get this type of reaction from someone in the medical profession.
So, here I am. I am writing this open letter, and will also share it with my YouTube community, because I hope that it helps another mother who finds herself in that situation. You see, I was frozen and couldn’t speak because I had my guard down in that office. Normally, when breastfeeding in public, I am always on edge and ready with my rebuttals should someone say something to me about breastfeeding my daughter. Any breastfeeding mother can relate to this. However, in the safety net of the pediatrician’s office, I had assumed that my continued breastfeeding would be accepted – not ridiculed. I am going to share with you some facts about breastfeeding so that if you ever find yourself in a situation where someone questions your choice to feed your daughter or son by breast, that you have something to say in return because I sure wish I had been able to say any of these things in response.
Mostly though, I am hoping that Dr. Engels has an opportunity to read this, or watch my video, and understand the impact that he had on somebody who wasn’t his patient and who was in his life for only a fleeting moment. I want him to know that words have strength and weight and should not just be said in an off the cuff manner. If another mother found herself in that situation, and was not as confident in her decisions as I was, she might leave his office and feel embarrassed or feel like she was doing something wrong. She might stop breastfeeding after that, even if she was not intending to.
If you, reading or watching this, have ever thought it was weird or odd or different for a mother to breastfeed her child past the age of one, I am hoping that this video helps you to understand the benefits and why mothers do breastfeed for an extended period of time. I think that people in general are more approving, less judgmental and more understanding when they are armed with information.
Many people have asked me, “Could the doctor have been joking?” and no, he wasn’t. Even if he were, it was still an extremely distasteful and ignorant joke. Other people have said, “Well, not everyone thinks that breastfeeding past one is acceptable” and no, not everyone thinks that, nor do they need to, but when you are in the medical profession, you generally keep your own personal opinion out of it and stick to facts that can be backed up with scientific research or medical fact. Having the opinion that extended breastfeeding is weird or asking someone if they plan to do it to an absurd age is not based on medical fact or scientific research. What this doctor asked me is offensive and very unprofessional.
Before I go into the facts about breastfeeding, I feel that it is very important for me to state Section 1 of the Human Rights Code, RSO 1990, c H.19, which states, Every person has a right to equal treatment with respect to services, goods and facilities, without discrimination because of race, ancestry, place of origin, colour, ethnic origin, citizenship, creed, sex, sexual orientation, age, marital status, family status or disability. The Ontario Human Rights Commission’s position is that the obligation not to discriminate on the basis of ‘sex’ includes an obligation not to discriminate on the basis of pregnancy, breastfeeding and gender identity.
This legal obligation is reflected in guidance contained in the Canadian Medical Association’s Code of Ethics, paragraph 17.
The experience that I had with this doctor is not simply an issue where I was insulted – this is an issue where I was denied my civil rights.
I want this text / video to contain education that will help others understand more about the benefits of extended breastfeeding so let me share those with you now.
Health Canada recommends the following: Encourage exclusive breastfeeding for the first 6 months of life, as breast milk is the best food for optimal growth. Breastfeeding may continue for up to 2 years and beyond.
The World Health Organization recommends exclusive breastfeeding for the first six months of life. At six months, other foods should complement breastfeeding for up to two years or more.
WHO also states that breastmilk is the ideal food for newborns and infants. It gives infants all the nutrients they need for healthy development. It is safe and contains antibodies that help protect infants from common childhood illnesses such as diarrhoea and pneumonia.
WHO states that beyond the immediate benefits for children, breastfeeding contributes to a lifetime of good health. Adults who were breastfed as babies often have lower blood pressure and lower cholesterol, as well as lower rates of overweight, obesity and type-2 diabetes.
WHO states that breastfeeding should not be decreased when starting complementary feeding.
A Dewey 2011 reference states that in the second year (12-23 months), 448ml of breastmilk provides: 29% of energy requirements, 43% of protein requirements, 36% of calcium requirements, 75% of vitamin A requirements, 76% of folate requirements, 94% of vitamin B12 requirements and 60% of vitamin C requirements.
According to the American Academy of Pediatrics, the role of pediatricians and other health care professionals should be to protect, promote and support breastfeeding enthusiastically and, in consideration of the extensively published evidence for improved health and developmental outcomes in breastfed infants and their mothers, a strong position on behalf of breastfeeding is warranted.
The AAP also states that pediatricians should promote breastfeeding as a cultural norm and encourage family and societal support for breastfeeding. They also need to recognize the effect of cultural diversity on breastfeeding attitudes and practices and encourage variations that effectively promote and support breastfeeding.
The sad part is that, in a study performed by the American Academy of Pediatrics, which involved a survey sent to 1602 active Fellows of the AAP, only 65% of the pediatricians surveyed recommended exclusive breastfeeding for the first month of life. Only 37% of pediatricians recommended breastfeeding for 1 year. The majority of the pediatricians surveyed had also not attended a presentation on breastfeeding in the previous three years however most said that they did want more education on breastfeeding. They concluded that pediatricians have significant educational needs in the area of breastfeeding.
Things need to change. My experience is unfortunately one of many. The attitude that our society has toward breastfeeding, and more prevalent to my experience, extended breastfeeding, is narrow. We especially need to work on creating more education for pediatricians and providing them with ample access to lactation consultants who can advise on such issues.
I hope this video reaches a mother who, like me, was ridiculed for breastfeeding past one year and I hope that it helps her realize that her decision is the right one. I hope it also provides other mothers with information that they can use to present to their pediatrician should an issue ever come up.
And to Dr. Engels, should you ever see this video, I would really appreciate knowing why you chose those words that evening and what your intentions were behind saying them. What made you think that breastfeeding my 13 month old daughter meant that I would breastfeed her until she was in high school? How do you support other breastfeeding mothers? What part of me breastfeeding my daughter is “legal in Ontario”? I have so many unanswered questions about our interaction and I’m hoping that this helps me receive answers.