Book Review

Permission to Mother: Going Beyond the Standard-of-Care to Nurture Our Children

Denise Punger, MD, FAAFP, IBCLC

Outskirts Press, 2007

There are two main reasons that Dr. Punger’s book is important. The first is that she started out with the same culturally imposed beliefs about birth and breastfeeding that most American mothers have. Often, mainstream mothers assume that ‘alternative’ mothers have always had ‘far out’ ideas. Yet the journey from culturally accepted parenting beliefs to heart-centered intuitive parenting doesn’t happen overnight or without good reason. Often it is the result of a great deal of research and soulful exploration. Permission to Mother is Dr. Punger’s journey. Part of this journey includes her medical training (and that of her physician husband), which is the second reason this work is so important.

People tend to assume that support of all safe birthing options, including homebirth, automatically requires that someone be ‘anti’-doctor or ‘anti’-hospital. Likewise, to advocate for breastfeeding is often taken as an ‘anti-woman’ stance. Somehow it doesn’t occur to certain folks that it is only their own erroneous assumptions about birth and breastfeeding that could lead to such conclusions. In any case, in this book, they are challenged. Dr. Punger IS a doctor. She is married to a doctor. Her father-in-law is a retired obstetrician. Obviously she isn’t anti-doctor. Yet she supports homebirth and doulas. She is a working woman; yet she’s a breastfeeding advocate. Her story is vitally important in putting to rest the ‘us’ against ‘them’ mindset once and for all.

Punger shares with us her education, training and early experiences. We hear first-hand just how little doctors learn about truly normal, natural birth and breastfeeding. She asks important questions about why obstetricians so often jump to surgical solutions when other, less invasive options abound for many variations (sometimes called complications). Her own breech home-birth ends up being part of that process of questioning.

Likewise, her discovery of Dr. Brewer’s advice which led to the elimination of toxemia from his own OB practice prompted her to ask, “Why does the medical community ignore his evidence?” Good question; midwives have been using this advice to help mothers to be healthy for decades. The information is there, and it is so simple. Why the resistance?

Perhaps the best part of this book is “Finding Breastfeeding Medicine”. Dr. Punger’s own breastfeeding experiences led her to supplement her education to become an International Board Certified Lactation Consultant (IBCLC). We learn elsewhere in the book that medical ‘training’ in breastfeeding may include an hour or two of instruction and continuing education sponsored by formula companies. What I want to know is why every single doctor (or nurse) that will discuss infant feeding with new mothers isn’t required to be a lactation consultant? Why isn’t every obstetrician, pediatrician and family practice physician required to be able to fully inform mothers of the benefits of breastfeeding and understand how to overcome challenges when they occur? How can they actually educate women if this isn’t part of their own education? How can they be of assistance if they don’t have the motivation to go above and beyond as Dr. Punger chose to do?

I love that the author shows that being a working woman doesn’t mean you can’t breastfeed. I love that she herself is so dedicated to her boys that she would have them brought to work to nurse them when she couldn’t be home. I actually chose my own daughter’s pediatrician for exactly that reason: the doctor’s husband brought her children to the hospital when she couldn’t go home to nurse them.

Because of this level of knowledge of breastfeeding, Punger is also able to address issues such as adoptive nursing and other special situations, as well as introduce the concept of breast-milk donation, which may be a new idea to some readers.

Finally, I’m excited about this book because also home-birthed, cloth diapered, breastfed, co-slept and unschooled my own daughter (who, by the way, is an intelligent, compassionate, independent young adult now, despite dire warnings of where our ‘weird’ parenting choices would lead). It’s nice to find a kindred soul.