“You think it will get easier?” The mother looks up at the doctor expectantly.
“Oh, sure it will,” Jack Newman replies. “This is the hardest time, when your baby is six or seven weeks old.”
“But I’m always worried about my milk supply,” says the mother, Karen.
It’s mid-morning and Karen is looking for answers at Newman’s breastfeeding clinic. She and her baby are in a meeting room because the four examination rooms are full. In one, a mother sits bare to waist with nipples so sore she cries when she nurses her baby, her husband says. Down the hall is a mom wondering how she’ll nurse triplets, and a couple who hope to breastfeed an infant they will adopt 10 days from now.
The 59-year-old paediatrician roams from room to room, answering questions, adjusting a baby’s position here, giving advice there about milk supply and babies who aren’t gaining. He pauses occasionally to talk to Edith Kernerman, the lactation consultant (LC) who is the clinic’s co-director, and two LCs in training. Today, Newman, whose clinic runs three days a week at the Canadian College of Naturopathic Medicine in Toronto, will see 15 to 16 moms and babies, answer 50 to 100 emails from mothers, health professionals and the media, and speak to three or four mothers by phone.
Compared with many of Newman’s clients, Karen is not so badly off. Her baby, Owen, is gaining well. But he often cries while nursing and comes unlatched, plus he has a tongue-tie, a web of skin that holds the tongue down and can interfere with sucking. For Karen, it all just doesn’t feel right. Her yearning for things to get better was obvious when she ran into Newman in the hall and reminded him she had come for help with her first baby. “I was here three years ago, and it’s not working again,” she said, punctuating her final word with a little slap on his arm — a gesture simultaneously playful and loaded. Her hopes are all but written on her forehead. She’s counting on the breastfeeding guru to save her.
Some call Newman a hero — North America’s top breastfeeding doc, a straight shooter who says things that need to be said, and even a champion of women’s rights. Others paint him as a radical who pushes breastfeeding too hard, occasionally upsets the mothers who turn to him, and is too quick to criticize his peers.
What everyone agrees on is Newman’s zeal and his knowledge about breastfeeding. He was born in Tel Aviv, came to Canada with his family in 1948, and took his medical training at the University of Toronto. His professional introduction to lactation came one day as a fourth-year medical student when he was asked to examine a new mother’s breasts, checking for lumps. Newman was stunned and mortified at the stream of milk that shot out of one breast. “I had no idea such a thing was possible,” he says. “They hadn’t prepared me for this in medical school.”
His interest began in earnest when the first of his three children was born 30 years ago. Newman’s wife, Adèle, breastfed their daughter and two sons — an experience he describes as natural but not always easy. His passion was nurtured when Newman spent 18 months working at a hospital in the Transkei region of South Africa. “I saw babies die because they were not breastfed,” he says. “The water used to mix their formula was contaminated, and these babies didn’t have the antibodies to fight off infections.”
His desire to help Canadian women solve breastfeeding problems grew during the time he spent as a staff paediatrician at Toronto’s Hospital for Sick Children, where he was surprised to meet mothers and babies struggling with breastfeeding on a daily basis. It was there that Newman started Canada’s first hospital-based breastfeeding clinic in 1984. Back then, he admits, he knew very little. Twenty-two years later, he knows a lot. Ask Sharon Woolf.
Woolf, who lives in Thornhill, Ont., has never met Newman face to face. But he’s solved her breastfeeding problems twice, by phone and email. Newman was Woolf’s last hope seven years ago when she had sore nipples that, as she puts it, “made everybody gasp at one breastfeeding clinic.” Her family doctor and a dermatologist had been unable to help. Newman nailed her problem in two minutes by phone — candida, a yeast infection. “Dr. Newman told me to go to the drugstore for some gentian violet (a purple dye used to treat thrush and vaginal yeast infections) and to paint it in the baby’s mouth and on my nipples,” says Woolf. “Within 24 hours, I was a new person.”
Mothers have tales of driving for hours to see Newman — one came all the way from the Yukon — or leaving him weepy, late-evening voice mail messages. But his influence goes beyond helping patients. Though he is often at odds with other health professionals — in 22 years he has lectured only twice on breastfeeding at medical schools in Toronto — Newman has profoundly influenced the way many people think about breastfeeding.
One of his revolutionary ideas is how to tell a baby is actually drinking. “When a baby is getting milk, you will see a definite pause in the movement of his chin,” he says. “That’s when his mouth is filling up. A baby who is not getting much milk will have a fast sucking pattern without any of these mouth-wide-open pauses. If we could teach all mothers to recognize this and how to get a good latch, it would prevent many problems, and they’d be able to cut through most of the bullshit they are told.”
The last sentence may offer a clue as to why a guy who gets such stellar results sometimes has an uneasy relationship with hospitals that have housed his clinics. Over the years, Newman’s clinics have been and gone at seven Toronto hospitals, most recently North York General. Hospital administrators will say they are funded to provide acute care and that they want to focus their resources on in-patients. (Breastfeeding clinics and lactation consultants have recently been cut in other parts of Ontario, as well.) Newman’s services can indeed be delivered outside of a hospital, although he prefers to be inside, where he can influence the support given to new mothers. “Ninety percent of breastfeeding problems could be prevented,” he says. “Getting mothers off to a good start is the key, and almost all start in hospitals.” Newman has left some hospitals of his own accord, but in other cases has felt that he was not wanted. That could be partly because of his willingness to criticize policies and practices.
At Etobicoke General, for example, Newman lobbied against a policy requiring that all babies born by Caesarean section be separated from their mothers for 24 hours. “Now it’s down to four hours, but only because of my bitching.” He has sent hundreds of letters to maternity wards or heads of paediatrics.
Such actions do not endear Newman to some colleagues. But others say he speaks truths that need to be spoken. Linda J. Smith, a lactation consultant and activist in Dayton, Ohio, says there is no one quite like Newman in the US. “He’s one of the best clinicians around and he’s not afraid to tell it like it is. Often, he has been two to five years ahead of the research.” One example: Newman’s idea to combine an antifungal and an antibiotic in one nipple ointment.
Being ahead of the research, however, leaves Newman vulnerable to accusations that his approaches aren’t always based on solid evidence. For example, some colleagues feel he is too rigid in his dislike of supplementing breastfed babies with bottles of formula, though the ones we contacted were unwilling to criticize Newman publicly.
Newman does not say that bottles always lead to early weaning, but he’s seen it happen and feels that most supplementation is unnecessary. He also notes that many past and present medical practices are not evidence-based. “For that matter, what study has proven that it’s safe to give a bottle of formula to a two-day-old baby whose gut was designed to get colostrum? I assure you those studies have not been done.”
How does this no-holds-barred approach play out with patients? The demand for his services, as well as the hundreds of mothers who wrote letters and the more than 2,000 who signed a petition to have his clinic at North York General reinstated, speak for themselves. However, his direct manner doesn’t work for everyone.
The third and last time Martha Davis went to Newman’s clinic, six years ago, she was near the end of her rope. Try as she might, she couldn’t get the latch Newman had showed her working at home. “He’d grab my breast, push the baby’s head towards me and, boom, she was on,” she says, “but it didn’t work at home.” She can’t remember Newman’s exact words, but the way she heard it was something like: “I don’t see what the problem is. Why can’t you get this going?” Her heart sank. “If the guru couldn’t get me latching, what hope did I have?”
She stopped breastfeeding, but pumped breastmilk for six months. During that time, Davis was sitting at a bus stop giving her baby a bottle, when she saw Newman coming. “I whipped the bottle out of her mouth and hid it in my jacket.” “How are things going?” Newman asked. “Fine,” Davis said.
Newman and Kernerman are convinced, based on the feedback they’ve had from clients, that such a response is very much the exception. And many mothers I spoke with describe him as kind, even soft-spoken, if sometimes “brisk.” Of course, his work unfolds in an emotionally loaded context, with mothers who can be frustrated and fragile, sometimes to the point of tears.
“Yes, mothers cry here sometimes,” Newman says. “Sometimes they cry because they learn things here that contradict the bad information they’ve gotten all along. And I think they cry more often for that, than because Dr. Newman made them cry. If I’m the lightning rod for their frustration and disappointment, it’s fine with me.”
That sounds almost cavalier until you recall that this is the guy who gives some patients unheard-of amounts of his time, answers more than 500 emails and as many as 20 phone calls a week, all for free, at times when he could be engaging in other favourite pursuits like birdwatching or crossword puzzles.
Newman has never made a cent from the nipple ointment he invented. The formula, along with other handouts and even videos on a variety of topics, is posted on several websites (see Newman’s Own). Apart from speaking engagements and book royalties, his only paid work currently is three days a week at his clinic.
Still, Newman recognizes that some women want and need more hand-holding than he provides. “That’s a large part of why Edith and the volunteers are here,” he says. “They take the time to look after the emotional side of a mother’s situation or to talk to them about things they don’t want to talk to me about.”
Newman sees his job as helping a mother breastfeed for as long as she wants help; don’t expect him to tell you it’s time to give up. He remembers one mother from early in his career who, he was convinced, had come to the clinic so she could say she’d tried everything before she quit. Newman suggested she try feeding her baby whenever he seemed to want it, rather than on the rigid schedule she had been given. She ended up nursing her child for more than two years. “What if I had told her that she had done her best, so she could quit and not feel bad about it?” he asks.
Back at the clinic with Karen and her son, Newman clips the baby’s tongue-tie — a blink-of-an-eye procedure that elicits a minute or so of crying before Owen calms down.
As the conversation resumes, Karen asks: “So, even if he drinks for, like, a minute, and only gets a couple of ounces, that’s OK?”
“Yes, it’s fine.”
“But everybody says he needs the hindmilk,” Karen points out.
“The hindmilk, the schmind milk,” Newman replies. “Sometimes I wish we’d never heard of hindmilk.” In the effortfully patient tone of someone who spends much time clarifying misconceptions, Newman tells her not to stress about the higher-fat milk that comes toward the end of a feeding. All breastmilk has fat content, he explains, so do what works. “If the baby feeds better by your putting him to the same side an hour later, OK. If not, fine, put him to the other side,” he says.
As he talks, Newman is holding Owen, who is sucking on the doctor’s finger. Owen starts to cry. “Let me show my little trick,” Newman says. He puts his right hand under the baby’s bum with his left hand supporting his chest, and starts moving him straight up and down, no rocking or swaying. Within a minute, Owen stops crying. As he hands the baby back to Karen, Newman gives him a smile: “If you want to stay cute, you’d better be good to your mother,” he says and moves to another patient.
Here are 10 key ideas, popularized or in some cases introduced by Jack Newman, that are now widely accepted among breastfeeding specialists who work closely with mothers:
1. Breastfeeding problems are challenges that can be solved rather than reasons to wean.
2. The most effective latch is the “asymmetric” latch — where baby is covering more of the areola with her lower lip than with her upper lip and where her chin, but not her nose, is touching the breast.
3. You can assess the latch by observing the change in baby’s sucking when she’s swallowing milk.
4. Newman’s all-purpose nipple ointment, which can be mixed by a pharmacist from instructions at breastfeedingonline.com, combines an antibiotic ointment, an antifungal powder and a topical corticosteroid.
5. Breast compression — gentle squeezing — can help babies get more milk and more high-fat milk.
6. Raynaud’s syndrome, a painful but treatable blanching, usually of extremeties such as fingers and toes, can sometimes affect a nursing mother’s nipples.
7. Milk oversupply can be decreased in some cases by nursing on one breast only, for several feeds.
8. Domperidone (a drug for nausea and vomiting) and herbs, such as fenugreek and blessed thistle, can be used to increase milk production.
9. Adoptive mothers who want to breastfeed can induce milk production more effectively using Newman’s protocol.
10. Tube-feeding on the nipple or a finger is a good alternative to bottle-feeding for babies who won’t latch on, or who need supplementation, because it helps train them to take the breast.
Dr. Jack Newman’s Guide to Breastfeeding by Jack Newman and Teresa Pitman, HarperCollins 2005.
Dr. Jack Newman’s Visual Guide to Breastfeeding — DVD available at drjacknewman.com ($30).No Comments