Most People Want to Breastfeed, But Need More Support To Do So

Dr. Cecília Tomori, Associate Professor and internationally recognized breastfeeding expert, responds to recent New York Times articles on breastfeeding and the overuse of tongue-tie release procedures.

The investigation misses the bigger picture: that the U.S. does not provide an enabling environment for breastfeeding.
Cecelia Tomori, Phd

In the U.S., 83 percent of new parents start out breastfeeding. But the number drops off quickly, with huge racial and ethnic inequities in a person’s ability to continue breastfeeding, ultimately showing that we do not have adequate support for those who wish to breastfeed.

The lack of support is the fundamental problem, and it is not adequately explored in the recent New York Times articles, “Inside the Booming Business of Cutting Babies’ Tongues” and “What Parents Should Know About Tongue-Tie Releases.”

The articles claim that American dentists’ and lactation consultants’ have been “pushing” “tongue-tie releases” on new mothers who are struggling to breastfeed, despite insufficient evidence. A tongue-tie is when the frenulum (a strip of tissue attaching an infant’s tongue to the floor of their mouth) is shorter than normal, making it harder for a baby to latch and breastfeed effectively. A tongue-tie release, or frenotomy, is a brief procedure where a physician or dentist cuts under the baby’s tongue to fix the problem.

It is certainly the case that some who claim to support breastfeeding do not have adequate knowledge, and some may even exploit the desire to breastfeed for profits. And a “quick fix” is especially appealing when skilled support is not available and new parents are struggling. What’s more, the New York Times reports that some professionals imply that addressing tongue tie will fix all ailments, which is not supported by evidence (nor is it the position of most lactation professionals). However, the investigation misses the bigger picture: that the U.S. does not provide an enabling environment for breastfeeding.

How do parents end up so desperate for a solution to breastfeeding challenges?

Our health system often doesn’t provide adequate opportunities for immediate skin to skin contact or opportunities to initiate breastfeeding within the first hour, which play a critical role in ensuring that breastfeeding is off to a good start. We don’t have adequate skilled lactation education and support available during pregnancy or postpartum. Health care providers lack adequate training about breastfeeding and don’t know how to evaluate and address common challenges. The most common “solution” for breastfeeding challenges remains commercial milk formula rather than addressing root causes of the challenges breastfeeding people encounter. Yet in most cases their concerns can be addressed through skilled support and education about typical infant behavior. A subset of cases requires referrals and further intervention. In some of these cases a tongue tie revision can be appropriate and helpful, but it’s important to have access to appropriate evaluation and support.

We should be cautious when a provider focuses on tongue-tie release as a miracle cure (or, really any “miracle cure”). No provider should “push” any treatment; informed decision making is an essential part of any clinical relationship.

But lactation consultants provide much needed support. And the New York Times piece implies they routinely receive financial benefits from referrals for the procedure, or that they always “push” for this procedure, which is incorrect.

Ultimately, we must recognize the need for much broader breastfeeding support to put this piece into context.

To really value breastfeeding means not only recognizing its importance for maternal and child health, but to invest in the systems that enable it. That includes everything from improving the health system in the workplace (we still do not have paid leave!) to enacting regulations that prevent unethical marketing of commercial milk formula.

In an enabling environment, parents have access to knowledgeable, equitable and evidence-based care and support for any breastfeeding challenges that arise.

About the Author:

Dr. Cecília Tomori

Dr. Tomori is an internationally recognized expert on breastfeeding, infant sleep, and maternal child health, and author of the 2023 Lancet Breastfeeding Series. Dr. Tomori is an Associate Professor and Director of Global Public Health and Community Health at the school of nursing at the Johns Hopkins School of Nursing, with a a joint appointment at the Bloomberg School of Public Health’s Department of Population, Family and Reproductive Health.