The One Best Way? is a fascinating history of breastfeeding and related infant feeding issues in Canada from before Confederation to the present time. Although what happened here during the 20th century is not essentially any different from what has occurred in the rest of the industrialized world, authors Tasnim Nathoo and Dr. Aleck Ostry (PhD) do a wonderful job cataloguing the idiosyncratic characters who defined breastfeeding in Canada—all of whom hold a candle to nobody in their arrogance, their unbending opinions of what’s right for others, and, yes, their love of children.

For instance, there was Dr. Helen MacMurchy, who wrote and edited the first four editions of The Canadian Mother’s Book, which were published between 1921 to 1932 and reached the parents of one in four live births during that time. Although not a mother herself, she assumed all mothers could and should breastfeed their infants exclusively for nine months.

There was also Dr. Alan Brown who, in 1919, became the first chief of pediatrics at the Hospital for Sick Children in Toronto. The rules he believed kept children on the right track—no night feedings from the first days and keeping to strictly scheduled feedings, for example—made his promotion of breastfeeding a hollow notion, and resulted in mothers likely not succeeding at the task. Although in later years he changed his approach, the die was cast and the remnants of his teachings from those early years have remained in pediatric training even today.

Yes, right from the first, many bemoaned the fact that physicians—including pediatricians—knew little about breastfeeding.

Nathoo and Dr. Ostry also demonstrate how cultural differences affected breastfeeding in the 20th century, as rates in Quebec—particularly amongst Québécois—were always lower than in the rest of Canada west of Quebec during this time period. But in the late 1990s, the government of Quebec took breastfeeding on as a priority. In addition to giving lip service to its importance, politicians actually put in place policies that have made a difference in attitudes among health professionals and has boosted initiation rates to 90% and perhaps higher. It is a tribute to what government policy and support can accomplish.

The book is full of interesting facts and figures and anecdotes. For example, I was surprised to learn the infant mortality rate (number of infants/live birth who died before a year of age) in Montreal in 1860 was one in three live births. This boggles the mind. Even as late as 1926, more than 100 babies out of every 1,000 live births died before the age of one year.

The authors also discuss the WHO International Code of Marketing of Breastmilk Substitutes as well as the Baby-Friendly Hospital Initiative, both of which have been poorly understood by Canadian health professionals. This book gives a good resumé.

They emphasize frequently that “education” of the mothers, with regard to the benefits of breastfeeding, has not worked and still does not work. While there can be no question that women want to breastfeed for the good of their babies and themselves (in some parts of Canada more than 90% of all new mothers initiate  breastfeeding), unfortunately, they are often blocked at every turn. Nathoo and Dr. Ostry point out that formula companies are extremely aggressive in marketing their products to pregnant women and new mothers. Advertising works—it’s that simple.

However, they point out much of the “failure of breastfeeding” comes from the undermining of breastfeeding that occurs through the health system. For instance, it is now well-established that many of the interventions that occur during labour and birth will cause the mothers difficulties with breastfeeding.

Epidural anesthesia, for example, is sold to mothers as a harmless way of feeling “no pain” during labour, yet not only do epidurals increase the risk of the mother developing fever during labour and birth, but the vast quantities of intravenous fluids that mothers get during the epidural result in babies born with “extra weight” and thus an increased risk of losing more than the “permissible” weight.

Furthermore, the edema caused by the I.V. fluids, which is so common postpartum, occurs not only in the ankles and fingers, but also in the nipples and areolas, with the result that the baby has difficulty latching on.

In short, Nathoo and Dr. Ostry have demonstrated that what was true in the 1920s is still true today. As a group, health professionals have usually had very little training in breastfeeding and thus do not know how to help mothers prevent problems, and do not know how to help the mothers and babies should problems arise. As a criticism, I really wish the authors had put their emphasis on health professional “education” because that is where the problem lies.

Overall, however, this is an excellent review of the history of breastfeeding and the politics and policies that surround it.