Moral Distress

or what's a Leader to do?

What is meant by the phrase “moral distress”?  One easily understood definition would be when one knows the right thing to do, but policies, procedures or the ‘rules’ make it very difficult to pursue the right course of action.

I can think of literally hundreds of examples when I was forced by my employer, or policies, or a doctor’s instructions to do something that I knew was not in the best interests of a woman and her baby. For example inducing labour to fit someone’s work schedule, rather than waiting until the baby signals that s/he is ready to be born does not usually work out well for mothers or babies. Caring for these women was a source of great moral distress for me, as the predicted pattern played out, right in front of me.

I am a midwife and can see there that there are many parallels that can be drawn between what’s happening with mothers giving birth  and to breastfeeding mothers.

Moral distress commences when firstly, a “failed” induction (who has failed is not specified, but mothers as women usually assume responsibility for the failures of others), followed by a caesarean section (because that is always the result of an induction that doesn’t work). The next step in the downward spiral is breastfeeding that doesn’t happen (because the overwhelmed baby won’t latch and then “excessive” early weight loss (without factoring in the excess fluid load that babies are born with because of their mothers’ many hours of compulsory IV fluids). So these babies exhibit a clinical need for supplementation, which unless they are very lucky, will be infant formula.

Start with a healthy woman who planned to have a vaginal birth and breastfeed her baby as her chosen path to motherhood. She leaves the hospital needing a lot of assistance at home because she is recovering from major surgery. Her baby may not be exclusively breastfeeding, so she has a plan that requires her to not only continue frequent breastfeeding attempts, but as well she needs to express her breasts regularly around the clock.

In addition to all this, she may already have other children to care for, her partner will be returning to work before she can manage on her own and her own mother, even if she is geographically close, may still be working too and unavailable to help.

Often these women feel like they have failed not only their babies, but at ‘being’ women at all.

And knowing all this, but having to go along with it, caused me intense distress and anguish. In the same way that watching a train wreck unfold would. I felt as though I was supporting practices that that were not only harmful, but absolutely predictable.

Giving birth is multi-faceted. It is the ultimate embodied experience and while not discounting at all the esoteric aspects of birth, the physiology is well understood, universal and predictable.

Many La Leche League Leaders are experiencing moral distress due to the actions of the Board of Directors. The LLL Board has created  language policies that result in the promotion of men attempting to breastfeed. Not only do these policies hurt women and children, they force Leaders to make a choice that often goes against their sense of ethical breastfeeding practices. Mothers’ and babies’ well being is an after thought, glibly traded for woke value signaling status. Sadly women’s health is also an after thought in our medicalised birth culture that often interferes with the natural process of birth.

First to go, is always the language. Somehow “women” and “mothers” are not “inclusive” enough, despite the fact that only the females of all mammalian species are the ones capable of conceiving, gestating and labouring to produce a new member of that species.

Birth and breastfeeding are solely sexed activities, totally removed from feelings, beliefs and esoteric philosophical discussions leaking out of the halls of academia.

So who are the words “women” and “mothers” excluding?

Well men for starters because as just stated they have no capacity to participate. Popping on a frock and growing your hair out does not change your reproductive opportunities at all. In fact, it is easy to find many examples of men who clearly experience a sexual frisson by wearing women’s clothing and adopting the mannerisms they assume are feminine. Autogynaephilic men absolutely should be excluded from mothers’ groups; they do not have any place there at all. Some men have actually stated a version of both ‘breastfeeding would make me feel more like a woman’ and ‘thinking about breastfeeding a baby gives me a boner’.

So it was utterly baffling when Leaders with concerns who contacted the Board for guidance around the issue of trans “women” approaching them for breastfeeding support, the LLLI Board stated that more research is needed in male lactation, not to demonstrate that this is not a good idea but to better support these men. Why they said this remains a mystery as they refuse to elaborate. Why would a mother to mother support organisation appear to sanction the removal of babies from their mothers to give to men to “breastfeed”? The limited amount of experimentation that has already been done clearly demonstrates that while a few men have managed to produce some fluid from their nipples, they are nowhere approaching breastfeeding as women understand it or as babies need it.

Being instructed to help men to practice at being women under the guise of breastfeeding is causing many LLL Leaders great moral distress because it violates the LLL Mission Statement:

“To help mothers worldwide to breastfeed through mother-to-mother support, encouragement, information, and education, and to promote a better understanding of breastfeeding as an important element in the healthy development of the baby and mother.” Philosophy - La Leche League International (llli.org)

Leaders have resigned, been disaccredited and removed from committees, not for refusing to help men, but for expressing concerns about the policy requiring them to help “everyone” to breastfeed (See No Boundaries, No Limits - by Lucy Leader (substack.com) to read this policy in full). Many have carried on, knowing that they signed their yearly Statement of Commitment under false pretenses because they have quietly decided that many mothers still need their help, but they will never help a man.

The other group that some state the words women and mothers are excluding are “trans dads”. These are biological women who have undergone surgery and are taking so called “cross sex” hormones (which are actually wrong sex hormones, used to help mimic the opposite sex) to appear to be men. Which to me begs the question of why they want to have babies at all, as pregnancy is surely the ultimate ‘proof’ of one’s female status.

There are two relevant issues around these women who choose to present as men in regard to moral distress in Leaders.

LLLI, an international breastfeeding organisation condones language changes that often result in women undertaking dangerous surgeries and ingesting powerful drugs that do not support healthy physical  bodies. These practices and choices women make to try to change their sex, while out of the scope of the Board’s reach are subtly being supported by the Board’s rigid attitudes on inclusive language. This so called inclusive language leads to the exclusion of mothers from receiving appropriate information and support from LLL Leaders. The gender ideology that promotes the removal of healthy breasts is not an empowering civil rights movement; it is an unethical commercial marketing blitz that has convinced women they were born in the wrong bodies. The costs to women’s health is enormous and growing. This “sex change”  industry is profiting from the suffering it bestows upon women over a lifetime as they become permanent patients whose natural health has been taken away from them through deception.  The Board must stop mixing causes with this belief system. It is harmful to women.

This cohort of breastless young women should be troubling for everyone, not celebrated as some “giant leap for mankind”. Of course as the age of alteration intervention trends younger and younger, there will be fewer pregnancies to deal with as puberty blockers followed by cross sex hormones causes irreversible infertility so these girls will not have to make a choice to remain childless and they will not need breastfeeding support groups for anything.

The second moral distress point for Leaders is in helping women who cannot breastfeed who ask for their help.

Leaders are all volunteer women who have breastfed their own children for an extended period of time and have undergone further training to help them in their work with LLL. The basis of the support that LLL was founded on is mother to mother support; the lived experience of being a breastfeeding mother is central to their role within LLL.

The scope of Leaders is the normal course of breastfeeding. Normal also includes experiences that not all mothers will share; prematurity, multiple births, some congenital conditions, some maternal conditions are also situations that most Leaders will encounter in the course of their role.

Different breast and nipple configurations may also feature and as with the list in the preceding paragraph, some Leaders may need to seek out some additional information or help to support mothers in their quest to breastfeed.

One thing that is way outside of the average Leader’s experience are women who have no glandular tissue (the vital bit where milk is made) and in an increasing number of cases, no nipples. (In what is euphemistically called “top surgery”, women are given a choice of whether or not to have their nipples reattached to their chest.)

If you have no glandular tissue to make milk and no nipples for the baby to suckle out the milk,  you cannot breastfeed.

Leaders can help these mothers in some ways of course. Skin to skin, keeping your baby close, responding to feeding cues; all this can be discussed with anyone who is caring for a baby.

But breastfeeding is so much more than just a way to feed a baby. It is a whole mothering toolbox and it is also about building a relationship with your baby that will endure forever. Formula feeding cannot accomplish what breastfeeding can and it is a substitute only in regards to meeting the caloric needs of a baby.

Most “chestfeeding” women will be using formula; only a lucky few will be able to source enough breast milk to satisfy their baby’s needs. Formula is not in the scope of Leaders’ expertise, even if they needed to use this as a part of their own breastfeeding journey. Formula feeding, unlike breastfeeding is not an “art”, but a science and getting it wrong (too much, too little, wrong proportions, or storage) can cause great harm and even kill a baby. Leaders cannot help with a fully formula fed baby in regards to that baby’s diet or nutritional needs.

Additionally, other factors change depending on what you are feeding a baby. Bedsharing/cosleeping is protective against SIDS/SUDI if you are exclusively breastfeeding your new/very young baby, but the opposite is true if you are not. Formula feeding combined with sleeping with a baby creates a risk for babies dying.

Leaders know this. And Leaders know that these women who have gone to extraordinary lengths to appear to change sex are missing out on in their denial of their sexual identity. Leaders have met women where they are for 65 years; they do not need a Board issuing directives that compels them to pretend that “everyone” can breastfeed when it is painfully obvious that some will not be able to do so.

Leader numbers continue to drop precipitously year by year. It was suggested on the LLL Leaders FB page that Leaders need “more education around inclusivity and diversity” to increase the number of Leaders who are volunteering their time and resources by a Leader who believes in gender ideology.  

I offer a counter argument: I maintain that moral distress is causing an exodus of Leaders. Leaders who became involved in LLL to help other mothers breastfeed are being given an impossible choice to make: Either help men -- and women who have tried to turn themselves into men to attempt to breastfeed over their own moral and safety objections, or leave the organisation. This is an extremely difficult decision for a Leader to make and an irresponsible position for the La Leche League Board of Directors to demand of Leaders. It’s time to stop distressing our Leaders and return to supporting the work of our mission.