Online book (free access) Breastfeeding – what’s the problem?

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If you are pregnant, you know there are many books about pregnancy, week by week, stage by stage, focused heavily on the first nine months of life, nurturing your growing baby, and preparing yourself for the life-changing event that is giving birth. Motherhood is an exclusive club; once you’ve joined, there is no turning back, but post-birth, you will probably find the level of truly supportive interest drops dramatically. Be prepared.

Prenatally, you will consider your options and pretty much decide how you’d like things to go. You will develop your own theoretical position and birth plan: pain-free birth, or ‘natural’ birth, birth position, water birth, hospital or home, NHS or independent midwife, and on it goes. No guarantees, but plenty of options. You will probably be encouraged to consider how you would prefer to feed your baby because once the birth is over, that’s the next episode. Babies need to eat. These are all important issues, but discussions only take you so far in preparing you for the early days, weeks and months of the responsibility for a baby. It is some years ago now, but it certainly came as a shock to my system first time around, and I felt I was well prepared, having read all the key books and attended all the classes, both NHS and NCT. Remarkably, despite my inexperienced ineptitude, my children survived.

A crucial part of raising your baby and enjoying motherhood is feeding her/him. You may well choose breastfeeding; some, from the outset, will not. This online book is mainly for those who do but it is, of course, open to anyone to read.

To any mother who has never considered the subject before (well, why would you?) it is hard to understand why breastfeeding your baby remains, in the twenty-first century, such a controversial subject, pitching woman against woman, evoking strong opinions from all sectors of society.

It should be a matter for purely personal decision-making and choice, shouldn’t it? After all, it is your body, and your baby, no one else’s. Yet, it will probably surprise you that everyone will take an interest in your choice, and all will feel better advised than you. Everyone will have a view on it, some more informed and supportive than others. Suddenly, your breasts become public property. You can begin to feel quite emotional about them. If every time your baby cries, some well-meaning person tells you he/she is hungry, then you also begin to start doubting your ability to feed your baby.

The breast or bottle debate rages on between mothers, creating a social divide, largely gender-specific, separating women into camps depending upon their attitude to infant feeding, a situation which has its roots in the social class system. It is curious that feeding a baby should arouse such emotion but the whole concept of motherhood has huge implications for women and how they live their lives; breastfeeding is perhaps best viewed as an extension of the way that women as mothers become public property.

The ‘process’ of breastfeeding itself has been problematised in contemporary modern society. It is what many might call a very ‘first world problem’ to be so hung up on something which is a basic need/right in other countries. Do mothers, existing at starvation levels of nutrition, argue over the rights and wrongs of breastfeeding? I don’t know, but somehow I doubt it. Survival rightly takes a greater place. But in the western world, especially Britain, breastfeeding is contradictory. It is still something of a social taboo, or something at best requiring ‘support’, something mothers cannot be expected to ‘naturally’ do; yet, the support that is needed is rarely forthcoming, and you are damned if you breastfeed, damned if you don’t.

It can be very bewildering. Suddenly, you have a baby to feed. You have probably never seen it done. You don’t quite know how it works, how milk is sufficiently produced, and you have never used your breasts in this way before. The pictures of contented breastfeeding babies show them snuggled neatly at the breast, but do not show the latching on process, the aimless rooting, the insistent hungry crying, the small amounts of milk actually taken; nor do they include the negative comments from significant others. I was surprised at quite how much effort needed to go into encouraging my first baby to feed, and how to get the position right to enable it to happen at all, especially when sitting delicately on a rubber ring following a difficult forceps delivery.  I was also surprised at how little help and support I received and how quick people were to encourage me to fail and stop. But that was twenty-eight years ago. Things have surely changed.

Well, maybe, maybe not…

Even in the twenty-first century, lay people and health professionals still tend to approach breastfeeding as merely functional, as a nutritious way to feed a baby, biological, something that is performed as a form of maternal self-sacrifice, ‘under sufferance’. It doesn’t sound great fun, does it? The shocking reality that we need to mention right from the outset is that many breastfeeding mothers derive pleasure from it and enjoy it; that’s the crux, and it is perfectly normal to feel that way.  What a crazy admission, that far from being totally altruistic, we women want what is best not only for our babies but also for ourselves. Keep your own needs firmly in mind because breastfeeding is most definitely a two-way process, and as with most things, the ‘what’s in it for me?’ school of thought plays a valuable part.

So, we need to approach assertive, confident breastfeeding as a pleasing art form or skill; it means we can elevate it to something enjoyable and enticing to more new mothers. Gone at a stroke is the routinely perpetuated idea as a mother as a form of ‘cow’ or ‘milking machine’ and instead, we have the positive image of a mother as a skilled practitioner providing optimum benefits to her baby, combined with a sense of feeling good, of maternal well-being. A ‘win-win’ situation.

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Breastfeeding is primarily addressed by the media in biological terms, invariably relating it to degrees of difficulty, so if we subvert this and try something radical, we then focus on the positives, perceiving breastfeeding as a ‘can do’ activity, a gift and talent, potentially pleasurable for mothers and indeed their babies. ‘Breast is best’ mothers are not martyrs, so the message is that breastfeeding is incredibly satisfying. Once you’ve cracked it, those endorphins fair fly during feeding, and you will feel good, if not elated. Why wouldn’t you want to feel like that? It’s a no-brainer.

Sadly, the odds are stacked against it happening because there are lots of pressures on new mothers out there. Make sure you don’t become a casualty. Stay strong and follow your instinct/gut feeling.

Google it…

 

Where does this pressure come from? A quick Google search for ‘breastfeeding’ was depressing but indicates what contemporary mothers are up against. It gave, in prime position, advice on breastfeeding from Aptamil, who call themselves ‘infant feeding experts’ and have the search engine optimisation to ensure they come high on the search lists. So, having breastfed five babies, I decided to also classify myself as an ‘infant feeding expert’. Why not? Suddenly, I feel empowered. As a mother, I could do something practical and beautiful which also required expertise.  Now, I can help others to do the same. Unlike Aptamil, I have no profit motive-based axe to grind, but nor do I have their Google clout.

The remaining listed Google items all seemed to problematise breastfeeding, showing us at a glance how ‘dirty’ it is, how ‘difficult’ it is and how ‘painful’ it is. Or, focusing on the ‘womanly’ art of how to remove stains caused by milk, how to avoid mastitis and similar maternal ‘avoidance’ conundrums. No mention of anything remotely to do with the ‘three Ps’: positive, proactive, pleasurable.

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No wonder that breastfeeding is perceived by so many mothers as difficult and unpleasant, even before they try it if they try it at all. Nothing there to express its perfection, its beauty, nor indeed its sensuality. So, let’s try to change that.

When she first felt her son’s groping mouth attach itself to her breast, a wave of sweet vibration thrilled deep inside and radiated to all parts of her body; it was similar to love, but it went beyond a lover’s caress, it brought a great calm happiness, a great happy calm. ~Milan Kundera

 

 

Chapter 1 – The ultimate convenience food…

 

We all know the facts, that as ‘ready meals’ go, breast milk is the ultimate convenience food: safe, warm and nutritious. In an age where speed is vital, breastfeeding for babies should be as popular as microwaveable meals for adults, with the added bonus that you know what’s in it, it is perfectly nutritionally balanced, just the right temperature, and it does not require a trip to Tesco to stock up. It means that if you’re shopping and your baby is hungry, you can feed her; if you are stuck in your car in snow (yes, been there) or you break down, you can feed her and after inoculations or when your baby needs comfort, you can feed her. Or him. Any time, any day, any situation, you never forget to take your breasts with you, little paraphernalia required.

Everyone knows the maxim that breast is best, in theory, but what was found on Google suggests it is considered just too difficult in practice for many women. So, why is breastfeeding publicly portrayed and perceived as so challenging for so many new mums?

The reality is that breastfeeding, despite many platitudes to the contrary, still gets a bad press in the UK, explicitly and implicitly. This undermines women, making them feel incapable. Breastfeeding competency is further eroded by profit-seeking baby milk companies, and sometimes by poor health care, questionable assumptions, and social labelling. The infrastructure of our society does not support women to breastfeed. For example, those wishing to return to work start their new lives, not by immersing themselves in the maternal experience, but understandably by worrying how they will wean a breastfeeding baby before their maternity leave runs out. Very few women now have the luxury of choice – not going out to work is not an option for many new mothers.

Then, of course, there are concerns about what other people think; some people are still very disconcerted by breastfeeding, and some of these are incredibly and powerfully vocal about it. Rather worrying, some of the most vociferous of breastfeeding opponents are women, the very people who ought to be supportive of the ‘sisterhood’ if that doesn’t sound uncomfortably feminist (which it might do because that’s another word that’s often used in a derogatory way).

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My motivation…

 

Let’s be clear on my motivation for writing this, so many years after I’ve stopped breastfeeding my own children. Even when giving birth wasn’t a great memory (and I had five goes at it, so they varied) I look back at feeding all my babies with immense fondness; it was not all plain sailing, but it was empowering, something I could do well without interference, a special link to my infants. It did not come easily the first time around. I’d had an instrumental delivery with many stitches, and at times it did downright hurt, but there is nothing quite like the feeling/sight of a contented baby post-feed for a mother who knows that she has, uniquely, shared immense closeness with her child, a level of physical closeness that, rightly, changes over time. It is a period in your baby’s life that you cannot later reclaim. It is, believe me, priceless, magical. Not waxing lyrical, merely a fact.

The moment she had laid the child to the breast both became perfectly calm ~Isak Dinesen

 

I need to be absolutely clear. Although I am a strong advocate of breastfeeding, I do not at all wish to blame mothers for not breastfeeding; there is more than enough guilt attached to every aspect of motherhood, indeed to womanhood, so I don’t need to dish out more. If you are breastfeeding, or plan to, great. You may find this a useful/interesting read. If you didn’t breastfeed, that’s fine, don’t worry about it, but if you want to next time or wish to think about and work through some of the issues behind your feeding choices, read on. You may be perfectly happy not to breastfeed but then you would probably not even be bothering to read this.

There does seem to be an unhelpful movement among the fundamental feeding police, the so-called ‘breastapo’ to alienate bottle-feeding mothers. Fundamentalist approaches to anything are worrying because of the erroneous conviction that one way is the only/right way.  This seems a great exercise in futility, which does not help increase breastfeeding rates or longevity of natural feeding. Nor does it make mothers feel good about themselves or more attached to their babies. Indeed, I cannot see any benefits to it at all. Motherhood doesn’t come easily or with instructions, so we all bring to and take from it, different qualities.

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Additionally, the idea that some amazing ‘alpha mothers’ breastfeed just as well as they appear to do everything else is also not helpful for most women, for we all experience the process differently, and indeed, will find the experience varies depending upon the baby, for it is very much a two-way process.  You quickly learn how your baby likes to feed, and s/he is learning, too. Some do not like feeding, however you do it, while some adore it. First time around, like anything else, you may find it more challenging, but once used to it, it becomes a whole lot easier and more relaxed. I could feed my later babies while walking around, at my desk, even on the phone. Whichever category, you can do it quietly and attentively. There is no need to hide breastfeeding, but likewise, there is no real need to make a big fuss about it.

The new mother many years ago who visited me at home, whipped out her breast and talked about ‘booby time’ was making a clumsy political point to the converted.  There was no need, and far more irritating than the sight of any breast was the use of the childish term ‘booby’. The aim of breastfeeding is not to make people feel uncomfortable or to alienate anyone; while I am totally pro a woman’s right to feed her baby where and how she likes, it is polite to bear in mind that some people will find it difficult due to attitudes developed from years of the media sexualisation of female breasts. Those ‘page three girls’ have had a detrimental effect. Others will have no problems with breastfeeding, but simply prefer more discretion.

Assertive breastfeeding is feeding confidently, quietly and without faff (from anyone, the breastfeeding mother included). Rather like surfing or swimming, ice skating, cycling or juggling, if you have mastered the art, you make it look effortless. If you are struggling to master the basics, are making a political point, or lack confidence, you will make a song and dance about it, draw attention to it, and appear awkward.

If a multinational company developed a product that was a nutritionally balanced and delicious food, a wonder drug that both prevented and treated disease, cost almost nothing to produce and could be delivered in quantities controlled by the consumers’ needs, the very announcement of their find would send their shares rocketing to the top of the stock market. The scientists who developed the product would win prizes and the wealth and influence of everyone involved would increase dramatically. Women have been producing such a miraculous substance, breastmilk, since the beginning of human existence ~Gabrielle Palmer

 

 

Chapter 2 – Encouraging breastfeeding

 

So, how can we encourage this beautiful art form: the art of breastfeeding?

Let’s start by taking a structural approach. The issues are more structural and cultural than individual so blaming individuals for their choices in pointless and unhelpful. Put simply, the contemporary UK parenting culture offers little help and encouragement to new mothers generally – many of whom are also socially and geographically isolated – and especially to those wishing to breastfeed. This needs a serious overhaul.

Too target led?

Research by Lisa Smyth (2012) published in the Ethics and Social Welfare Journal, explored breast promotion campaigns in the UK. She concluded that target-driven health-promotion contributed to the ‘burden’ of early motherhood in unhelpful ways.  Yes, not all early motherhood is an absolute delight, nor is later motherhood. She suggests that while some women find breastfeeding enjoyable, providing a real sense of maternal achievement (the kind of feeling I hope to encourage) this is for others potentially damaging, leading to feelings of failure and loss of self-esteem, so already there is a spectrum of experience partly caused, in part, by health service target setting, which has an economic (funding) basis. Breastfeeding discussions tend to take place in terms of percentages and ‘success rates’. Smyth argues that breastfeeding ‘targets’ are not helpful, drawing a strong distinction between ‘rational’ and ‘irrational’ feeding methods, overlooking the importance of social factors in baby feeding choices.

Rather than banging on about some moral imperative to breastfeed, she asserts it makes sense to just make the process easier for mothers by strengthening the right to breastfeed across the UK and strengthening employment rights, while also ensuring that clear and “context-sensitive” advice is given about formula feeding. If the social context is right, then breastfeeding will occur more naturally. We can here see the impetus moving away from individual mothers and their choices, to strengthening the prevailing social structure to support mothers wishing to breastfeed, which makes a good deal of sense.

Smyth demonstrated this with the point that women had no legal right to publicly breastfeed in Northern Ireland (though this has now changed) and that this may partly explain especially low levels of breastfeeding in that region at the time, for all the pro-breastfeeding strategies on earth will be at odds with the message that breastfeeding is somehow publicly offensive/illegal. Interestingly, an article in the Irish Journal from August 16th, 2015, mentioned that hundreds of Irish babies were being breastfed in public at a ‘non-event’ – and no one noticed.

Smyth is right. Targets, in many ways, have no place in breastfeeding. It is not a business model. You cannot get an A* in the subject; we cannot turn mothers into academies, nor should we want to. I still clearly remember being woken twenty-six years ago by a midwife who asked if I’d fed my sleeping baby and if so, how much milk he had taken so she could fill in a chart. I didn’t know, but it was enough to make him sleep, which allowed me to sleep. So, it was obviously fine. Result: one irate and tired new mother woken for no reason other than box ticking. And did that episode help anyone or prove anything? No.

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Historical breastfeeding

 

It would be interesting to know if breastfeeding was ever considered straightforward for most women, or whether the natural process has always been problematised. I’m no social historian but there will be research out there, somewhere.

In the distant past, there was little choice, if women did not breastfeed, other than to get some other woman in as a wet nurse, usually some economically poor unfortunate who had lost her own baby. Generally, however, hiring a wet nurse was viewed as a luxury of the higher social classes. Whether the lower orders just got on with it – which I suspect they had to – is probably documented somewhere. Failing that, infants presumably were given alternatives and in some cases, sadly died. Worrying about it seems a predominantly middle-class problem. In Victorian Britain, it is suggested that 80% of mothers breastfed, a figure which decreased in the 1920s and reached its lowest level in the mid-1970s when the figure for the UK was a mere 24%.

Yet, of course, it wasn’t simply class-based. For there are feminist arguments that suggest that breastfeeding is a natural way of population spacing, and was used as such before the advent of reliable contraception. Passing a baby to a wet nurse meant the mother not only became sexually available to her husband more quickly but she was able to produce more children, for full breastfeeding often inhibits menstruation (indeed it has been used as an – albeit unreliable – contraceptive) in many women. There can also be an impact on libido (not always).  So, wet nursing among the upper and middle classes had a hidden agenda of making wives more sexually attractive/available to their husbands/ready to breed. It was thus more of a service to men than to women. Perhaps one sees the rumblings of social disapproval here, for if breastfeeding reduced fecundity, then it was presumably considered socially undesirable. Meanwhile, desperately poor women were practising coitus interruptus, inserting all sorts of vaginal suppositories, or even having backstreet abortions to avoid the unwanted pregnancy that for many would be the last straw in very difficult lives, often ending fatally.

Not entirely irrelevant, a fascinating piece of research, a scientific study of breastfeeding habits in medieval England by Dr Simon May et al (2003) found that extended breastfeeding not only shielded children from the very high levels of infant mortality otherwise expected, but it also enabled medieval babes to thrive and grow as well as modern babies. Once the breastfeeding stopped, the detrimental environmental impact kicked in.

Many medieval mothers would wean at six to nine months, when their own meagre diets left them less capable of producing sufficient milk, but even so, partial breastfeeding mitigated against the contaminating effects of food and water until about the age of eighteen months, thereby giving babies a good chance of surviving the crucial first year, having much the same effect as in developing countries today. I’m not sure how far we’ve moved on since then, though water supplies in the west are obviously much better.

 

Now – disempowered?

 

Now, most western women would cringe at the idea of another woman feeding their babies, but are happy about giving a bottle of formula. Is this change cultural, political or economic? Or all three?

Do we simply live in a society where economics rules, big business dictating that parents should buy expensive formula? He who markets most aggressively wins. Even buying a report on the baby food and drink market in the UK cost a massive £1750.00 when I last looked, so it is hard to see quite what the market is worth, but it must be immense.  The baby milk/food market was hit by a decline in the number of births in 2013, which led to a decline in volume sales. However, prices have risen to help compensate for that, because companies will always make their money somehow. The ongoing birthrate decline between 2014-2019 means that marketing baby milk/foods has/will become more competitive, with scope for companies to boost their appeal by harnessing the ‘healthy’ connotations of products and looking again at feeding stages. Look out for the hype about follow-on milk, and so on. The scant details I accessed suggest that the market drivers for formula milk are:

*average age of mothers (now 30)

*less than half of babies are breastfed after 6-8 weeks

*a rise in real disposable income

*uncertainty/concerns about sugar content in infant foods

which the baby milk manufacturers will exploit in their marketing. As an example, we see that while baby food is declining, baby milk, including fortified cows’ milk, are growing. Per capita expenditure on baby food was estimated at £865.80 a year. It’s not cheap, £16.65 a week to be precise.

So, the first thing to notice about formula milk is that it is big business, with profit as a key driver. Companies have massive marketing departments – and budgets – to entice mothers to use their products. Breastfeeding has no such advocates pouring money into its promotion because relates to public wellbeing/health rather than profit. While formula milk companies may claim to support early breastfeeding (perhaps for 6-8 weeks) they are keen to see mothers ‘fail’ as it immediately means they have no choice but to buy formula milk. Ker-ching! The, at times dubious, marketing strategies baby milk companies employ globally are widely discussed on the internet, and free to access so you may fancy doing some research.

There are occasional problems with the safety of formula milks. For example, in December, 2017, there was a global recall by formula manufacturer, Lactalis, a large dairy producer in France, due to a salmonella outbreak at their factory.  While up to 7,000 tonnes of product may have been contaminated, the company did not know how much was still on the shelves or had been sold/consumed, in itself worrying. It seems that in December, 2017, 20 babies have been reported with potentially-related sickness. In 2008, 6 babies died and 300,000 fell ill after Chinese manufacturers added melamine (industrial chemical) to their products, which is a huge number. Formula milk is a global issue, and the provenance of that milk is not always clear until there is a scare.

Scares are not regular, but they do happen, as they do throughout the food industry. That said, it is not always big business that is the problem. A Belgian couple were convicted after their baby died from a diet of vegetable milk. It seems the mother did not produce breast milk and the baby refused formula. Once again, we have a system failing parents and more importantly, babies.

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Food, generally, is becoming a huge social issue in the UK. With highly questionable contemporary diets, rich in salt, sugar, and additives, there is the question of whether breast milk is as good as it should be, anyway. The whole food industry needs an overhaul, including infant feeding. According to Diabetes UK, the UK is officially the fattest country in Europe with 1 in 5 adults overweight and 1 in 15 obese; the number of obese people is set to rise 73% over the next twenty years to 26 million people. 1 in 3 children are said to be overweight, with 1 in 5 obese; this is currently still rising in older children, aged 11-15 but has slowed in younger age groups. Bear this in mind for later, for breastfeeding is thought to help counteract childhood obesity and diabetes.

On the infant feeding front, equally importantly, mothers seem to have become so disempowered that they no longer know how to breastfeed their babies. Pregnancy and birth have become over-medicalised and midwifery desperately under-funded, leaving mothers at the mercy of so-called ‘experts’ who simply don’t have the time to properly instruct and support them.

Additionally, many families live in such geographical and social isolation that mothers are unable to learn from the other women around them, their mothers, their sisters and friends. Instead, they have to rely on supportive organisations, these increasingly cash-squeezed and time-limited, for the help and advice which might have once been their familial right. Many new mothers will never have seen breastfeeding happen, so it is understandable if it seems alien, mysterious or just plain at odds with everyday life.

Chances are, low longer-term breastfeeding rates rely on a combination of highly structural factors, including geographic mobility, changes in the employment position of women, massive changes in the food industry, low numbers of midwives who have the time to help mothers to feed, and fewer killer childhood diseases – in the UK – for which breastfeeding has traditionally offered protection; all have inhibited its progress.

 

Invisibility

 

Some 2010 research by Hoddinott et al suggests that vicarious experience gained through seeing other women breastfeed “may influence feeding decisions and efficacy”. The research included a longitudinal study which included a Seeing Breastfeeding Scale consisting of five attitudes:

I felt embarrassed

I felt uncomfortable

I did not know where to look

It was lovely

It didn’t bother me

Women who had seen breastfeeding occur within the preceding 12 months were more likely to see it as ‘lovely’ and to have a positive attitude towards it. So, in a way, public breastfeeding is educational. This is probably not your main motivation but it maybe counteracts any negativity you may encounter.

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Patronising?

 

Most books and articles work hard not to alienate bottle-feeding mothers. As a freelance magazine feature writer, I regularly wrote such commissioned articles (and questioned why) for magazines, where breastfeeding and bottle-feeding competed for equal attention, so all mothers felt included.  In truth, such an attitude, though well meant, can be misguided and patronising, though no one wishes to alienate any mother doing her best for her child. However, women are not stupid.

If mothers choose to bottle-feed, that is their decision and their right. They have exceedingly good reasons for their choice, but we should not, for fear of upsetting them, then deny the truth that breast milk is nutritionally superior to any formula. It is easier for a baby to digest, exactly suiting her/his needs at any specific time. It offers immunological protection, especially against respiratory and gastrointestinal infection. It also offers tailor-made close contact – a mother doesn’t need to have ‘cuddle time’ for she is automatically embracing her baby every time she feeds; the feeding position is different for a breast-fed and bottle-fed baby. It also helps to reduce later obesity, a major issue in contemporary Britain. Given the choice between an organic vegetable, or a genetically modified one at the same cost, I suspect most of us would choose the organic one. No, formula milk is not genetically modified but it is laboratory-led, containing processed skimmed dairy milk, with added vitamins, fatty acids and prebiotics. Some are ‘casein dominant’ for so-called ‘hungry babies’. Despite all this innovation, breast milk is still pretty much the ‘gold standard’ for babies.

Social structures (media, advertising, healthcare medicalisation) all heavily promote the idea that formula is just as good as breast milk. It isn’t, but it is okay, a socially acceptable alternative, and a viable, if expensive, one in developed countries. In developing countries, it is a whole different story as the Baby Milk Action website will tell you in fine detail if you wish to find out more.

It is true that bottle-fed babies in countries with pure water supplies do of course thrive and grow, and it would be ridiculous and unhelpful to suggest otherwise – indeed, the centile charts used to monitor infant growth were traditionally based very much on the expected weight gain of formula-fed babies, which has, in the past disadvantaged breast-fed babies, my own first child included. Being judged on these scales presented her as ‘failing to thrive’ which at the time was very worrying, not least because she seemed healthy enough and I hadn’t a clue what it all meant.

It is peculiar how weight gain in babies is a positive, but by the time we get to obesity in five-year-olds, it is a very different story. Breast milk is now, however, seen as the superior option in terms of longer-term benefits, too, such as reducing the growing risk of diabetes in childhood and, more controversially, positive links with greater ‘intelligence’ or academic achievement, though this is moot and may also have a socio-economic basis.

Breast milk cannot go far wrong, despite occasional scares; it is always clean, of the right composition for a baby’s age, the correct temperature and readily available. Colostrum before the milk comes in is also amazing for babies. Breastfeeding should also be fulfilling for both mums and babies, and it confers benefits for women. If we are thinking health and beauty, then note that the extra calories used up by nursing your baby can help with weight loss by depleting some of the fat reserves deposited during pregnancy; it enables the uterus to return to pre-normal size more quickly, as anyone who has suffered cramping after-pains as the uterus contracts during feeding will testify. Best of all, it makes women less prone to osteoporosis and pre-menopausal breast cancer. But yes, unless you are careful you may occasionally leak milk onto your dress! I once thought I could get away with wearing a plain blue silk dress with a back zip at a wedding (while still breastfeeding) which, of course, was not the case, as I leaked nicely down the front, and feeding was a nightmare. Just a little sense was required.

Breast milk is otherwise very convenient, and free, which makes great sense when on a tight budget, but sadly it is the very women who struggle to survive economically who are more likely to bottle-feed.

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It has become a great modern myth among women that they won’t produce enough milk. Yet women in far worse environmental conditions manage to produce some milk for their babies. Also, there are widespread beliefs that breastfeeding will be painful because of sore and cracked nipples, that a woman’s partner won’t like it, that it will restrict mothers, and that people won’t approve; all negatives, and generally social in origin. Interestingly enough, many mothers do indeed suffer these problems, or in the case of the first two, are given poor quality advice which leads directly to them – they are, therefore, very real issues which need resolving. We need to investigate why women have become so convinced of their own failure as mothers and why they are still receiving such dire advice which fulfils that prophecy.

Some people do also find breastfeeding strangely offensive. There are lots of articles in tabloid newspapers by inflammatory reporters who talk of women finding breastfeeding offensive but being scared to say so because of some mythical ‘bullying sisterhood’. To be fair, columnists on tabloid newspapers are paid to be controversial. It is hard to quite understand what the issue is. I’ve seen people eat on trains or in the street. I’ve seen people on the streets without any food or shelter at all. Strikes me there are more important things to get het up about than public breastfeeding, such as rampant consumerism, homelessness, and the growing need for food banks. Maybe people need to first question their own motivation.

This description was given by a (male) primary school teacher some years ago:

I was obliged to sit through a PTA meeting last night while a parent breastfed her baby.  It was ‘disguised by one of these broad, sling style affairs but none the less gross for that.

Said teacher was not a father, incidentally. No surprises there then.

In 2011, Joan Wolf asked ‘is breast actually best?’ which led to an outpouring of critical discussion. Her argument was that the scientific evidence about the health benefits of breastfeeding was rather lacking (and it can be difficult to disentangle the social from the physical) but she did raise feminist questions about why parenting always tends to be seen as the mother’s responsibility. She questions the so-called ‘sacrosanct’ nature of breastfeeding, suggesting it shouldn’t be. I question it, too, given most mothers choose either not to breastfeed or stop breastfeeding quite early. How does putting mothers off breastfeeding so readily make it in any way ‘sacrosanct’? I’m also not sure how one can argue that commercially produced formula is better for a baby than naturally produced maternal milk which predates laboratories. Wolf, in my view, concerns herself with minor issues here, though I accept that breastfeeding (or not) is a ‘loaded’ process for mothers. Rigidity is not the way forward but removing barriers for those women who wish to breastfeed their infants is. I like to think we have reached a turning point and that natural ways forward are perceived differently now.

There is a more modern phenomenon I’ve encountered; that of parents, usually not geographically mobile, with close family nearby, wishing to continue their social lives as before a baby’s arrival, with minimal disruption. Extremely understandable ( I seriously thought life would go on as before but with a baby tucked under my arm when I had my first child) but incompatible with parenting, alas. These are babies who, in the early months, are passed around the family for care, who go for ‘sleepovers’ or, even, holidays with grandparents and other doting relatives, to ‘socialise’ them. They are probably more likely to be bottle-fed because it means they can exist/thrive quite readily without constant maternal attention. This communal form of child-rearing is not necessarily a bad thing if grandparents are willing to be substitute parents (who knows?) but it does mean breastfeeding is likely to be impeded.

Whether it also affects the long-term bonding/attachment process is an interesting question. I’m not yet aware of any research on it. But it makes infant feeding something anyone can do, rather than a special quality of a mother. The formula milk companies must be clapping their hands but, to me, removing that sense of the special seems a retrograde step, especially in the early months, because if motherhood is not considered special, then it is a hell of a lot of hard graft for nothing much.

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Controversially…

 

People need to understand that when they’re deciding between breast milk and formula, they’re not deciding between Coke and Pepsi… They’re choosing between a live, pure substance and a dead substance made with the cheapest oils available ~ Chele Marmet

 

 

Chapter 3 – Breastfeeding – a social construction (or you do have a choice…)

 

To understand how breastfeeding is not simply physiological but is socially constructed, it is worth checking out a now rather aged but still interesting sociological paper by Alison Bowes and Teresa Meehan Domokos (1998). They examined how Pakistani women in the UK negotiated breastfeeding both in hospital and at home. While ethnically specific, the results perhaps have wider application, though this is obviously not generally considered to be the case with small-scale ethnographic studies. If nothing else, it is pause for thought.

The social factors surrounding breastfeeding are complex, but the authors of the study argued that if feeding is viewed as socially negotiated, rather than simply physiological, then we can gain fresh insights on how women choose to feed their babies. That is what makes it interesting research.

Negotiated? Explain…

 

The whole concept of negotiation is based on the idea of individual agency, or choice. There is one school of thought that believes our lives are seriously determined by society, with rules and ways of behaving imposed from outside by structures/institutions like work, family, media, and so on. Put simply, we do as we are told – or raised – to do, whether we realise it or not, like wearing a seatbelt is something most of us do automatically, unthinkingly. Following this school of thought, if we are poor or young, for example, we will be less likely to breastfeed because it is less likely a part of our upbringing, so there are structural hurdles to overcome.

A different school of thought conversely implies not quite that we have total ‘free will’ but that people actively engage with these social structures, so we behave in an individualistic way. Put simply, it is the capacity to know what ‘society’ expects, but nonetheless, to then make our own choices. It is a whole lot more complex than this but this fits our needs for now and is the ‘negotiation’ mentioned in the study. Some people obviously find ‘negotiating’ easier than others.

What this study did was to introduce the radical notion of agency to the subject of breastfeeding, challenging the prevailing idea that women are simply absorbent sponges, passively absorbing and accepting, without question, whatever information they are fed by health professionals, depending upon whatever the current thinking is (and this does change). After all, as the women in this book demonstrate, not all health professionals are terribly knowledgeable about breastfeeding; many will have been influenced by their own negative experiences, and indeed, the formula-milk promotions they encounter along the way.

Instead, think of women as active learners, social agents, who take on board information, norms, and mores by adapting their usefulness to suit their own circumstances. This makes much more sense than some outmoded model whereby specific knowledge is somehow injected into us, disregarding how we process that knowledge.

Very aware of social roles and societal expectations which have become internalised since childhood, all people process and use the information to give them some power and say over their actions and choices in adult life. Some have more opportunity to listen to their own voice than others depending upon the resources they have available.

For example, educated, articulate professional women, have more means (or social/cultural capital) at their disposal in deciding upon the pros and cons of breastfeeding, such as access to books, the internet, health professionals and parenting groups such as NCT and La Leche League. They may feel more confident about challenging and questioning prevailing information. Nonetheless, that can still be thwarted/disrupted by poor levels of professional advice, for our socialisation and inculcation into the dominant culture, continues throughout our lives, and first-time mothers especially, are dealing with something very new and different at a time when their confidence level is likely to be low.

Whatever your social class position, having a first baby is a major life event and one which many women still find intensely shocking when it happens because no amount of reading – or talking – prepares you for the reality.

 

Successful breastfeeding might depend on your social situation …

 

Most women give birth in hospital, contentious but not an issue for discussion here, simply stating facts. However, breastfeeding in hospital is something of a hit and miss affair, which can very much depend upon professional support, both its quality and nature. Breastfeeding at home can also be a lonely struggle if mothers don’t have family at hand or the positive support of a knowledgeable and proactive community midwife/health visitor. Even women who successfully breastfeed while in hospital can hit hiccups once home, and it is often at that time that targeted support is needed, but generally not fully available. In October, 2015, Independent Nurse magazine mentioned a shortage of full-time staff, which is forcing community midwives to cover shifts in the acute sector, with 65% of on-call community midwives called in to cover hospital shifts. There is a shortage of approximately 2600 midwives in England, so the system is creaking along and mothers are getting a raw deal, not because of the individual personnel involved, but because there are not enough of them to provide the input they need for new mothers at home. It seems that midwives are keen to hand over to health visitors mothers who are coping well, but informal discussion suggests that the mothers prefer longer contact with the community midwives while establishing care routines and breastfeeding.

To reiterate, successful breastfeeding is still most likely to occur for white, middle class women with effective stocks of knowledge and the ability to articulate their feelings, but for women in more socially excluded groups, less able to effectively negotiate with health professionals, success is less likely. Therefore, breastfeeding remains a social class and ethnicity issue. If there is a language barrier, too, the level of exclusion is surely higher.

The Bowes and Domokos paper importantly points out that while women may be encouraged to breastfeed, the decision isn’t all down to individual free choice, as there are wider social forces to consider. Many new mothers remain terribly socially constrained by the expectations of others, such as partners, culture, and even the demands of early returns to paid work. So, in promoting breastfeeding as traditional, natural, and right, in a society which does not actively support such a stance, mothers are dealt a disservice, one which needs addressing.

For many of today’s mothers, and probably since at least the 1950s, breastfeeding is something that is not natural, women know little about it; many have never seen it happen and need to learn about doing it successfully, just as they’d need to learn how to set up a blog or learn to drive a car. To not have that store of knowledge is an educational issue, but also says something about changes in family life/structures, where breastfeeding is now rarely seen in practice. Additionally, while literature suggests that pre-industrial societies also adopted other methods, that breastfeeding is not universal and that at certain times, other methods are promoted more, the difference today is that the alternatives are funding by major corporations who pour vast sums of money into advertising their product, making it the norm, not the exception. Like other foods, milk substitutes are a massive industry, aggressively marketed.

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Liberating or sub-ordinating?

 

Promoting breastfeeding is a double-edged sword. On the one hand, it may help encourage women to breastfeed; on the other, there is a danger of subordinating and alienating those very women, so it’s a tough line to tread.

There are feminist arguments that bottle-feeding is liberating for women, removing them from the medical control that so often accompanies breastfeeding, which should be a mother’s choice, not a health professional’s preference. It also means that mothers are less tied to their babies for feeding in the early months. Yet most women who choose to have a baby enjoy the unique tie/link to that new life because that is pretty much the idea of having one; furthermore, there is much to be said for being tied to a baby rather than a formula-milk company.

It probably depends on how you view motherhood. I hate to say this, but if you think a breastfeeding baby is demanding, watch out for toddlers and teenagers and, these days, even ‘infantilised’ adult children who fail to fly the nest. The demands of breastfeeding will be replaced by other more socially curtailing demands as your child grows. In a way, it is helpful preparation for the ongoing umbilical cord situationbetween mothers and their children…To be honest, the demands and constraints of motherhood generally seem to be largely at odds with the freedoms promoted by feminism, and therein lies a whole different discussion.

The question here is what happens when you do have a baby?

Certainly, formula may be seen to help to remove one of the ‘chains’ of motherhood, enabling a mother more freedom and separation from her baby, if that is required, while also enabling fathers to be more involved in infant feeding, though of course, there are many other ways to be an involved father. A father’s realisation that he cannot breastfeed is simply an acknowledgement that his role will be vitally important, but nonetheless different.

Another feminist argument is that women are falsely seduced (using something of a ‘false consciousness’ explanation) into breastfeeding because it removes them from the workplace, given working outside the home and breastfeeding are still largely incompatible in the modern UK, though that has improved. However, if there was a huge conspiracy to stop women working then presumably breastfeeding would receive greater emphasis. The statistics on working mothers probably don’t stack up to support this argument.

Yet, formula-feeding puts mothers at the mercy of good old capitalism and the promotion of a foodstuff which is expensive and not always in a woman’s – or her baby’s – best interests. The cost of formula milk alone is terrifying. And, given research into fractured families, where 1 in 5 newborns do not live with both parents, and 45% of parents are not together when their children reach 15, should society actively be encouraging mothers (and fathers) to ‘disengage’ from their babies so early?

Where does ‘promoting’ breastfeeding end and ‘forcing’ mothers into trying it begin? Well, for any women who has ever received support during breastfeeding, it becomes obvious that good support is very ‘woman-centred’. The person who can best show you how to breastfeed in a – literally sometimes – hands-on way is a woman who has herself breastfed. There is a certain sisterhood in women supporting other women, especially through friendship, family and even support organisations. And, when the skill is mastered, it is maternally empowering. The most difficult birth can quickly fade in one’s memory if breastfeeding works well.

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How we negotiate breastfeeding choices…

 

The crux of the Bowes and Domokos paper suggests that women negotiate their initial decision of whether to breastfeed or not: some mothers are, from the outset, determined to breastfeed, others are committed to the idea, some are aware of health promotion in the field, while others will be totally against the option. Women who did not breastfeed either made a positive choice to bottle-feed, or rejected breastfeeding because of not liking it, feeling embarrassed by it, or due to problems with the baby, especially those relating to prematurity.

For some Pakistani women, perhaps wishing to immerse themselves in the local culture, bottle-feeding was viewed as western and modern, and family considerations were also important. White women, conversely, tended to be less influenced by family and more autonomous in their decision-making, but some did seem to be influenced by a generation of bottle-feeding mothers before them. My own late mother always told me she could not breastfeed because her nipples were inverted – they were not. Her choice was probably more likely based on under-education, and difficulties feeding my premature older brother and the prevalence of a bottle – feeding culture which developing during the 1950s.

Ignoring womens choices…

 

Worryingly, the study mentioned some women who wanted to breastfeed but who bottle-fed because hospital staff assumed they would. Having a baby is an emotional experience and not a great time to have to be assertive. Staff should ask the questions and listen to the answers but it doesn’t always happen, so can tend to push women into specific choices. This coerced order meant, disturbingly, that the actions and intentions of women had little or no effect on the outcome, which is a problem for drives like Baby Friendly Initiatives. Two of these women had disabilities, which may well be related to further societal disempowerment of disabled women.  Some women also gave up breastfeeding because they had not received the help or advice they wanted when in hospital after the birth; bottle-feeding was perceived as easier (perhaps in terms of staff time) and women were not given the chance to learn the skill of breastfeeding – for it is a skill, an art.

I can relate to this following the birth of my first child in 1989, which had been a botched difficult forceps delivery, with bad enough vaginal wall tearing to require immediate repair under general anaesthetic. While I persevered with breastfeeding, no one helped me with feeding her (e.g., optimum positioning for latching on when Mum can barely sit down) within the hospital setting for two whole days. My baby was taken to the nursery and ‘formula fed’ as I recovered from the general anaesthetic (despite my birth plan stipulating that I intended to breastfeed) which was distressing. When later my daughter wasn’t a keen feeder, health visitor advice was to ‘supplement’, which would have totally messed up the supply-demand situation for a mother with a reluctant baby, or indeed any baby.

The care I received during the birth and postnatally back then was frankly dismal. Breastfeeding lasted for a difficult and, at times, dismal, six months where my small baby, although perfectly healthy, was labelled ‘failing to thrive’. That said, she wasn’t keen on alternative forms of food, either, apart from pureed fruit once she was old enough to have it. She is now, incidentally, grown up, gorgeous, decently tall and perfectly fit, active, and healthy, a very competent cook, with a good appetite. She was just low birth weight and had (then), as a very sensible paediatrician explained, very skinny parents which meant she was probably just following her genetic make-up.

Post-natal care issues…

 

One woman in the Bowes and Domokos study gave up breastfeeding because she saw hospital staff as rushed off their feet with no time to help her. The same woman did not attempt to breastfeed her second child but regretted her decision and planned to try with her third. In the event, she had twins and gave up very quickly. This also raises questions about why women are so polite during labour, which probably comes down to the great female problem of not wishing to be viewed as demanding or needing help. Somehow, we really think we should all be superwoman and take everything in our stride.

Hospital staff, it seems, are key players where geographically or socially isolated women often have no other means of knowledge and support, and maybe they inadvertently rely on the undemanding nature of many first-time mothers to make their own workload more manageable. How sad then that so few health professionals still appear to be adequately trained – or ‘interested’ enough to offer appropriate care. Hospital routines/systems can often seem to come before the needs of mothers and seem to be linked with an increasing level of self- care, leaving mothers to do much of what was once general nursing care themselves.

Problems with breastfeeding are sadly perceived as problems a mother has, not problems which are exacerbated by the system and which may be overcome with time and help. Too many mothers report failure to obtain help although, of course, there are glowing examples of midwives who are keen to assist, often caring in very basic ways such as by bringing numerous cups of tea to a new mother to keep her fluid levels up while breastfeeding. Once a mother goes home (quite quickly these days, even after operative deliveries, like Caesareans) then the amount of support is often close to negligible in a struggling midwifery service which is creaking due to shortages.

Postnatal care has long been the Cinderella of the maternity services. Care during pregnancy is generally of a high standard, but anyone who has been on a busy postnatal ward will know that staff shortages mean that midwives and nurses have little time left for helping mothers to establish breastfeeding. The current trend towards a quick discharge from the hospital, while desirable in many ways, may also be part of the problem, alongside poor continuity of care, of mothers never managing to establish breastfeeding. Of course, some NHS Trusts stand out as beacons, but others are still lacking. When I gave birth to my last child in 2001, I was astonished that not only was formula available but it was already mixed in bottles for grandparents and any others who seemed to want it, to administer to babies.

There is also, it seems, a difference between support and nagging. Some women in the Bowes and Domokos study felt ‘manhandled’ by staff trying to encourage breastfeeding. At a time when your body has been prodded and poked by all and sundry, such attention isn’t always welcome, especially if a woman is succeeding alone. The role of hospital staff, in particular, is crucial in the early days of establishing breastfeeding, especially after a difficult or traumatic birth, or where there are problems with latching on. This seems to be a major training issue.

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From interviews with middle-class women, criticisms of the hospital staff were plentiful, with many advised to offer supplementary bottles, a practice to which the mothers strongly objected, especially when they had specified breastfeeding in their birth plan; after all, why have a birth plan if it is simply ignored? Mothers who had successfully breastfed before often felt an urge to help other mothers but felt it was not their role – why not?

If a hospital’s staff is too busy and overworked then such peer support can be a godsend and surely should be encouraged? When women are too socially afraid to assist each other, it is a sad indictment of the state of postnatal care – and sisterhood – in this country. We British are just way too polite.

Breastfeeding is nature’s health plan. ~Author Unknown

 

 

 

 

Chapter 4 – Special care babies (or ‘too small to feed’)

 

By approaching breastfeeding positively, then stories of other women’s success should serve to inspire not intimidate, and this is partly the aim of this book, to show that even when the odds are great, women can feel empowered to breastfeed when appropriately supported. No woman should feel a failure if breastfeeding doesn’t work for her because the likelihood is that she has received inadequate help from the health infrastructure or her social network (or both).

As times change, then so do the issues which confront women as mothers.

‘Insufficient milk’ production is often used as a reason for stopping breastfeeding. Interestingly, the 1990s, a time of dramatic reproductive change with more couples seeking and using fertility treatment, meant a resulting increase in twins and multiple births. What developed from this is the empirical knowledge that even mothers of triplets should be able to, with support, feed all three babies, though it is probably exhausting, and certainly not easy.

Unfortunately, babies who need it most, those requiring special care, are even less likely to be breastfed than other babies, when their daily care is taken over by a medical team. These more vulnerable babies would perhaps benefit most from their mother’s milk, but the full trauma of having an early or unwell infant should not be underestimated. That said, mothers who feel disempowered and helpless when their babies need special care often find breastfeeding creates the bond they need. They feel vitally important amidst the intensive support systems – and they are.

Kate’s son, Simon, was born at 27 weeks’ gestation. She didn’t find the birth experience a happy event; she couldn’t cuddle her baby until he was ten days old, which is hard for someone who hasn’t been in that situation to imagine, she couldn’t show him off and do all the things that new mothers like to do, but what she could do was to offer him her breast milk:

All I could do for him was to breastfeed using a pump to express and a tube to feed. The midwives expressed surprise that I wanted to do that but I don’t know what I would have done with myself otherwise; at least it felt like I was giving him something.

Providing a link with a baby the mother may not even be able to properly touch can be vitally important. Additionally, there are excellent medical reasons for giving a mother’s breast milk, as colostrum in the early days is highly protective and superbly nutritious. It also truly involves a mother in her baby’s care. It ensures breastfeeding becomes established quickly, an opportunity which may otherwise be missed and soon fades. Long term, if a mother wishes to breastfeed, regardless of her baby’s early problems, then she must have a supply. Despite the claims of some health professionals that a breastfed baby will not gain enough weight, help is available. Ideally, it should be offered in all hospitals, which should now be, or aspire to be ‘Baby Friendly’.

UNICEF’s Baby Friendly Status, which started in 1992, was hailed a success, which most maternity services have achieved or are working towards. Acquiring such status requires units to follow ten steps to successful breastfeeding, though Lisa Smyth (2012) suggests this has been regionally patchy. Although long applauded, Smyth suggests that the problem with such campaigns is that it de-contextualises human action from its “situated and biographic contexts.”

In plain English, what she means is that campaigns like this once again assume women to be passive objects who can be moulded accordingly depending upon what is the current thinking, so we need a changing focus on treating women as key participants in the care of their babies, rather than treating them as acquiescent. However, it can be very hard for anxious parents not to accept medical or nursing advice about their baby, even if it is contrary to their own beliefs. There are strategies to promote preterm breastfeeding, and the decision to breastfeed following a preterm delivery is often a way of parents taking control of care. Sheila, whose baby Liam spent four months in special care after being born at 27 weeks noted that:

He felt like their baby – I always had to ask permission to do anything.

Parents are, of course, becoming increasingly knowledgeable and many realise the extra immunological and protective benefits, along with more recent claims that neurological and intellectual development may be influenced by breastfeeding. The key to successful breastfeeding of a preterm baby seems to be focusing on the mother’s successes.

Jo, a Birmingham – based midwife, once explained to me that she saw every breastfeed as a success, whether a mother chooses to do it once, fifteen times or a thousand times. What a positive and inspirational message, and certainly one to benefit special care mothers.

There are practical strategies to assist mothers of early babies. For preterm care, mothers need to express their milk little and often because prolactin levels drop after three hours and less frequent expression will inhibit production (the old supply-demand issue). Restrictions can also lead to painful engorgement. Additionally, full emptying of the breast is important. If the let-down reflex is hard to achieve, the easiest way to get it working is to put the baby to the breast but of course, this isn’t always possible. If the question of baby weight gain arises, cup feeding can offer some answers-for fat in milk can adhere to tubes in tube feeding which reduces the calorific intake.

Four special care mothers interviewed were critical that expert help is often unavailable once a special care baby has gone home. Often, problems persist but the advice just isn’t there. Specialist health visitors are needed who know about both breastfeeding and preterm feeding characteristics to empower parents to maintain their central role and be in control of feeding their babies.

A mother’s personal history can play a vital role in determining how much and what type of support she needs with breastfeeding and other issues. Debbie tells of her experience of breastfeeding Jamie who was born six weeks early. Her first baby was breastfed for a short time; her second son was, very sadly, stillborn ten weeks prematurely. The agony of having milk but no baby was difficult for Debbie to describe. When Jamie was born, she was determined to breastfeed, but, understandably, was not sure if she would be able to.

He was small (around 5lbs 6oz) and ventilated for a short while after birth. Initially, he was tube fed and given a mixture of formula, donated breast milk, and my own expressed milk. I was able to do the tube feeding which was a great psychological help for me but I really wanted to get on with feeding myself. I was lent a breast pump by the hospital and allowed to take it home.

I’d had a fairly easy birth, going home 48 hours afterwards. I religiously tried expressing as often as I could but felt woefully inadequate. I was lucky to get an ounce out at a time. I kept persevering but felt very silly coming into hospital with these plastic bottles with such small amounts of milk in them.

Soon after, it was suggested I have a go at putting Jamie to the breast. Very tentatively, I tried. He seemed able to get the idea and started to suck. It soon tired him out. He sucked for no more than 5 or 10 minutes but, miraculously, when I next expressed milk, the supply was more plentiful, so it just goes to show that there is no substitute for the real thing.

The special care nursery had quiet rooms set aside for feeding, which greatly helped being able to relax and try feeding. I was lucky in having very supportive midwives and nurses around. So began day long visits to the hospital where I would wait until Jamie wanted his next feed. As a premature infant, he was very sleepy and often needed waking for a feed. Each time he didn’t suck for long. At each feed, I had to weigh him before and after to see if he’d got enough. It seemed ridiculous. If he hadn’t reached the correct weight after a breastfeed I had to top him up with formula or breast milk from a bottle or through his nasal tube. Jamie didn’t particularly like bottles so it was back to tube feeding. After a while, I started lying about his weight after a feed, to avoid giving him bottles and tube feeding. Perseverance paid off. I was soon given the good news that once feeding was established we could take him home. The day before he came home I stayed in for 24 hours in a small flat attached to the special care nursery. Twelve days after the birth, Jamie was home. Neither of us ever looked back.

The community midwives and health visitors were congratulatory about my breastfeeding a premature baby but quite frankly, it was far easier than the attempts I had feeding his full-term older brother. I stopped feeding him when he was ten months old by which time we were both ready to stop. I hope that being breastfed gave him as good a start as he could possibly get.

In Debbie’s case, mixed messages were being given. Luckily, she had the perseverance and strength to continue with her breastfeeding, with appropriate help and support, but the underlying message behind the congratulations was that staff didn’t expect mothers to breastfeed special care infants successfully, nor for such babies to thrive without intervention.

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Some mothers may have qualms about donor milk. Debbie jumped at the chance of her son receiving some, as she was initially producing so little milk herself, but knew that breast milk was best for babies. She was assured that donors are screened for AIDS, etc., but as a point of concern, she added:

I was at a talk by a very eminent paediatrician who has done a lot of work on how very low birth weight babies develop into their teens. There is a higher than normal incidence of hyperactivity, psychological problems and learning difficulties in these children. He postulated that part of the problem may stem from the fact that the growth in the brain is somehow retarded during the very important stage of around 40 weeks gestation (when most babies would still be in utero). He suggested that preterm babies may actually require something more than breast milk.

The Tommy’s website suggests that vital vitamins and minerals which a preterm baby misses out on from the womb may be administered intravenously or through a tube, depending on the stage the baby has reached. This is maybe the solution to the something more concerns, rather than the heavily promoted formula with additional supplements which are courted among health care professionals by milk companies.

While breastfeeding may not seem the right choice for every parent, it is the best choice for every baby. ~Amy Spangler

 

 

 

Chapter 5 – Social stigma (or breasts are really just for sex, you know…)

 

It seems incredible that well into the twenty-first century we are still having to discuss breastfeeding in terms of social stigma, yet breasts are freely visible in most media, and, of course, online, yet to breastfeed in public still stirs heated, angry debate.

The National Childbirth Trust (NCT) has long been a staunch defender of breastfeeding, working hard to encourage greater acceptability of public breastfeeding. There have, in the past, been catalogues of horror stories on the subject. Women have been treated appallingly for breastfeeding in public places: the street, museums, shops, and on trains. One mother who was harangued in a museum for feeding a tired, hungry baby complained at the highest level. She made the point that if ever she sees another woman similarly treated then she would not fail to support her. Many of us, embarrassedly, would slink away and feel bad about ourselves – rightly – for so doing. However, it is now illegal to ask a breastfeeding woman to leave a public place, so the law is on your side.

Still, it takes some strength of character to stand up to the ‘feeding police’ when a new mother often feels very vulnerable. I remember hiding in my car, or even a public toilet to feed my first baby, feeling all the time that this was so wrong. My own mother-in-law once asked me (in my own home) if I could feed in another room as it embarrassed my father-in-law.  Rather stupidly, I did, though not with later babies. I also used to ask people who visited me at home if they ‘minded if I breastfed’. What was I thinking of?

Ideally, we shouldn’t have to take a stand, but while archaic notions of breastfeeding as ‘obscene’ abound, then we have to tackle the issue. Watching ‘The Vagina Monologues’, or more recently,Miranda, the point came home how many people are unable to say the word ‘vagina’. The same almost applies to ‘breast’.

This ridiculous sense of stigma seems to be a peculiarly British problem. In Norway, public breastfeeding is no cause for embarrassment; it is the norm since very few mothers even contemplate bottle-feeding. The Norwegian Government supports the breastfeeding of babies in a way which ours doesn’t. There, breastfeeding rates are high. Feeding for over a year is not unusual, but such ‘prolonged’ feeding is further stigmatised in Britain.

One holiday many years ago, as my family walked around the castle in Talmont St Hilaire, France, along with several other nationalities, a woman’s quiet labour caught my eye. She was unashamedly breastfeeding her infant. Yes, her breast was visible while she tenderly stroked her baby’s dark hair as he joyfully suckled. Her left breast was heavy, veined and so very different to the sexual breast of a non-feeding mother (though maybe some celebrities try to clone the full heaviness through silicone). It was free, uninhibited, fulfilling its function. No one seemed to be offended. She walked around feeding, too, so she could check on her other children. I smiled and pondered. Why could such a loving act be carried out without comment in rural France and not in the shopping centre of a UK city?

Why focus so much on this mother? Well, she became almost symbolic to me. Firstly, how wonderful and completely right that this mother felt able to breastfeed in a relaxed way in public, although we do not, of course, know how she felt about it. It may have been an immense act of courage on her part or it may have been totally natural. She certainly seemed relaxed. In the UK, to breastfeed so overtly would have required great single-mindedness and assertiveness. No fracas was created in Talmont. By comparison, remember the old horror story of the British woman and her baby who suffered the assault of a bucket of dirty water being thrown over them during discreet public breastfeeding in Marlborough? The assailant likened it to urinating in public, disgusting and obscene. What a problem this man seemed to have with feeding a baby. The media is full of similar stories which indicate an ongoing problem with public perceptions of breastfeeding, but we are chastising/penalising the wrong people.

Even if women’s breasts are now defined and classified entirely as sexual objects, the heavy, blue-veined, pendulous breastfeeding breast defies such a description. It is obviously milk-filled, not to expand cup size as an alternative to breast implants which many are all now so hung up on, but to provide basic human nourishment for a baby.

Given motherhood is still revered as a prime female function, it is odd that feeding the said baby is not. It is hard also to think why some people may find a breastfeeding breast sexy, although sensual is perhaps a better description. For anyone who finds the sight of a breastfeeding stranger anything other than tender, then they should perhaps question their own perceptions. The design of a woman’s body is a marvellous thing, made for nurturing. Breasts are specifically designed for feeding babies. According to journalist Harriet Griffey, any woman with breasts is capable of feeding her baby: “even women who have adopted their babies have been able to breastfeed partially with special help and advice”.

The sight of a breastfeeding mother is now so rare that we have to offer new mothers detailed written instructions or descriptions of how to do something which is best learned visually, by seeing other women unashamedly and unthinkingly feeding their babies naturally. The woman in Talmont was thereby unwittingly providing a public service.

Breastfeeding rates in Britain are around 8 out of 10 babies breastfed at least once, rapidly dropping by three months despite breastfeeding initiatives and Baby-Friendly hospitals. Why? Because coupled with the onslaught of marketing by the baby milk companies we have simply not developed a breastfeeding culture but an anti-breastfeeding one, where to breastfeed is considered unusual if not peculiar, and to do so for longer than six months is tantamount to obscenity.

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A Guardian article from 2016 mentioned that the UK has the lowest rate of breastfeeding in the world, which is shocking. The report, in The Lancet, mentioned that while 80% set out breastfeeding at birth, but by the end of week 1, over half of these have had formula. Only 1 in 200 women breastfeed their child after reaching their first birthday. Reasons given were social pressure on new mothers to get their babies into feeding routines and to sleep through the night. Amy Brown of Swansea University, however, explained that women are being pushed into feeding regimes where babies are not feeding enough (around every two hours) and therefore milk production is compromised. Frequent feeding is necessary and that includes night feeding. Brown’s study of around 300 women who stopped breastfeeding in the first six months cited pain (80%), public attitudes (40%), lack of support from others (60%) and embarrassment (20%). Brown feels that we need a complete societal change about our views on not only breastfeeding but motherhood.

“I think it is a huge cruelty to women to tell them that there is something wonderful that they should be doing and then to make it very difficult for them to do that.”- Rebecca Schiller

“This sense that ‘achieving’ or ‘accomplishing’ breastfeeding is the responsibility only of the mother and therefore [a] judgement as to whether she is ‘adequate’ or not, I think is one that I would counter strongly. There are so many things that make it more manageable to breastfeed than not. All of those things chip away at a woman’s confidence as to whether she has enough milk”– Dr Nigel Rollins, WHO

 

Women who choose to breastfeed for any length of time must be unswerving in their decision. Women need confidence in their bodies, not constant undermining of their ability to feed their babies by the promotion of baby formula or unfriendly breastfeeding practices, nor the pressure of weirdly negative public opinion. A campaign for higher quality mother and baby rooms where mothers feed in privacy is a good one, not to hide away breastfeeding but simply in making it easier for mothers to feed in comfort, but it is public breastfeeding which will change our culture. It is seeing mothers feeding their babies which will encourage future parents to choose best feeding practices and to support the right of women to feed – one reason why I happily fed my babies in front of the incredulous school friends of my children who had never seen a breast used for that purpose before though no doubt many had seen topless sunbathing or newspaper nudity without surprise.

Times are changing. In 2012, a woman called Lucy-Anne Holmes wrote a letter to the then-editor of The Sunrequesting that the newspaper reconsidered its use of Page 3 as sexually objectifying women. I remember as a child and a teenager being embarrassed by Page 3 in the tabloids, and later irritated, nay, infuriated, by them. By January 2015, The Sun had apparently withdrawn the feature it had run for forty-four years. The Sun didn’t stop being sexist but media representations of women were challenged by the campaign. It was a start.

When an actress takes off her clothes onscreen but a nursing mother is told to leave a building if she feeds a baby, what message do we give out about the roles of women?

In some ways, we’re as committed to the old Madonna-Whore dichotomy as ever. And the Madonna stays home, feeding the baby behind the blinds, a vestige of those days when for a lady to venture out was a flagrant act of public exposure. ~Anna Quindlen

 

Nursing does not diminish the beauty of a woman’s breasts; it enhances their charm by making them look lived in and happy. ~Robert A. Heinlein

Harry French (2017) from Utrecht University has studied (at undergraduate level) the repression of women who negotiate the breastfeeding of their babies.  The work is introduced with this example of public breastfeeding:

“It’s shocking that we’ve still got this sexual ‘thing’ about boobs” writes Leah Gibson (Daily Mail 2014). Gibson was the organiser of a 2014 protest outside the Nottingham branch of Sports Direct in response to 25-year-old Wioletta Komar being kicked out of the store for breastfeeding her newborn.

The author adds that one reason some women feel embarrassed about breastfeeding in public is due to ‘exposure of themselves’, deemed by some to be inappropriate. In western culture, the breast is sexualised, so that stimulation of the nipple using the mouth is perceived as a specific sexual act. It, therefore, becomes fetishised. The default position is to see female breasts very much related to sexual use rather than maternal, so the ‘display’ of breasts (though most women generally feed their babies fairly subtly) is perceived as ‘inappropriate’ at best and ‘pornographic’ at worst.

Female breasts, the argument continues, are considered exclusive (not for general consumption) but also ‘for others’ (only significant others, like male partners). Only heterosexual couples are really covered by French’s work. Women, it suggests, consider their own breasts to be ‘sex toys’ for others, rather than specifically for pleasure for the woman herself or for the feeding of her baby. Additionally, the cultural use of garments such as bras covers them (exclusivity) on the one hand but also enhances/promotes their attractiveness (to others).

It is a curiously phrased and perhaps over-academic piece but the gist is that mothers feel repressed and dissuaded from breastfeeding for various reasons. General social censure does not help, but also the father may actively discourage breastfeeding as he struggles with the sexual/maternal separation.

The role of men, as in most aspects of life, is important, and they can be a vital component of a woman’s decision not to breastfeed (especially in public). However, I struggle with French’s suggestion that most mothers see their breasts as “for the exclusive pleasure of their partners”. As a woman, this seems to me plain wrong. However, it would be wrong to dismiss it totally, so it is worth including.  We do know that the issues with public breastfeeding can make the whole process (and life as a mother) too difficult and thereby cut down breastfeeding rates.

The view of significant others, as we have seen, does have an impact on feeding choices.

 

Chapter 6 – Younger mothers (or too immature to breastfeed?)

 

Younger mothers are subjected to many negative stereotypes just as young people generally are. They are often targeted when it comes to promoting breastfeeding, as ‘those least likely to’. Reality is, if you’re old enough to have a baby, then you are old enough to breastfeed it.

There is a refreshing and growing awareness among young women that the old order needs changing. Melissa, who, when interviewed, was a 24-year-old mother with a nine-month-old daughter, was still breastfeeding when she contributed her thoughts.  There is a serious problem in encouraging younger mothers to breastfeed when we have a distinct lack of breastfeeding role models, so it was helpful to hear Melissa’s perspective.

Of all the mothers I know in my age group, not one of them breastfed for more than a couple of days even though they profess to know that breast is best. I came across three women who were extending breastfeeding but they were all thirty something. The sad thing is that most of the mothers I know gave up because of minor hiccups. I believe that people are too sympathetic towards these minor problems which cause women to give up breastfeeding. I had engorgement, cracked nipples and even bleeding in the first couple of weeks. At some points, I was even reduced to tears with the pain, but I survived an extremely difficult Caesarean section so I knew I must be strong enough to get through this. I wouldn’t give up my experience of breastfeeding for anyone – it is the most beautiful experience in the world to snuggle up with your baby at night as she suckles to sleep at your breast.

I have also received negative stares from people in public but that makes me all the more determined to feed my baby publicly. The irony is that people can’t even see anything. I don’t wave my breast around for the whole nation to have a look at. They just don’t like the idea of what we are doing. Anyway, if I don’t show young people that this is normal and just another of nature’s beautiful miracles, who else will act as a young role model for them? There’s no one else round here doing it so I see it as my duty to society. I also refuse to degrade my baby by feeding her in these smelly nappy changing rooms or mother and baby rooms which are really just a public toilet with a changing mat and an uncomfortable chair, not the nicest environment for breastfeeding mothers.

I breastfeed because I see it as the greatest gift I could give my baby and I just wanted to give her the best of everything within my means. My husband supported me every step as did my mother, mother – in – law and my aunties who all breastfed for at least several months and at the most three years.

From Melissa’s strong and positive views, it seems that what is most important to encourage younger mothers to breastfeed is support from their partners, mothers and siblings (here, there is a family history of supported breastfeeding), the confidence to feed in public (along with better feeding facilities for those mothers who prefer to feed their babies in privacy) and help with the minor irritations, or more complex issues, of breastfeeding to empower mothers to find their very real skills at feeding their babies. Of course, she is right about the mother and baby rooms. They are indeed often glorified toilets.

Not only is privacy an issue for many mothers, but often women have toddlers in tow – they need to have their child safe while they feed. While such rooms are slowly improving, they can be like sitting in an isolation cell. As supermarkets offer free baby milk, bottle warming services and nappies, they should also be thinking of providing a pleasanter environment for breastfeeding mothers, which also does their other shoppers a service by readily satisfying the needs of a hungry baby.

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The Money Advice Unit suggests that to fully bottle-feed a baby will cost £450 a year. Along with the cost of nappies and other baby paraphernalia, that can be a huge cost.  The cost of formula milk can also have tragic consequences when families are struggling economically, which many younger parents are. Some people will remember the tragic story which hit the front-page headlines back in 1999, following the death by salt poisoning of the three-month-old baby, Leroy Elders, though fortunately, such events do not happen often. The caring young parents of this baby, encouraging him on to solids (because of the high cost of formula milk) fed him mashed potato and instant gravy, along with Ready Brek cereal, which left him with salt levels up to eighteen times over the safe limit for a child of his age. A verdict of accidental death was delivered.

An education problem, certainly, but when interviewed, Leroy’s mother, eighteen-year-old Joanne Short, mentioned that she tried to breastfeed (obviously aware then of the financial savings) but it didn’t work, so they switched to formula which they then could not afford. Let’s face it, formula doesn’t come cheap; there’s money in it, and once you start, you can’t stop using the product just because it is expensive, but if you’re strapped for cash, then the temptation to skimp is there.

Leroy’s parents had read the books. They started to liquidise adult food for Leroy (thinking it was good and healthy, having read an old baby care book written before so many foods were highly processed) in order to save money as the baby was introduced to solids, but unaware of the high salt contents of the modern instant foods they ate. A different but related issue is that children are often no longer taught to cook, to know the nutritional values of foods or the dietary requirements of certain vulnerable groups, so they do not realise that ready-meals are often stuffed with salt, sugar and additives. In these difficult economic times, it is once again often necessary to cut back on expensive foodstuffs including formula milk. Hopefully, we are seeing a growing awareness of where our food comes from and what it contains, but there is still a long way to go, and in this instance the consequences were unthinkable.

Let’s pause to check out that comment: breastfeeding didn’t work. When an eighteen- year- old living in sub-optimal conditions of severe financial hardship wants to breastfeed her baby, surely we, as a society, are seriously failing that mother and baby if we are unable to offer the support needed to empower her to breastfeed successfully – it is, after all, the cheapest and most nutritious option and would doubtless have saved this particular baby’s life. Joanne Short isn’t alone in cutting back on formula to save money. It obviously isn’t developing countries alone which suffer from the obscenely high costs of formula which parents are cynically induced to use.

A professional article noted that while many British children appear relatively fortunate, one in three (4.4 million) are shockingly born into a life of poverty, despite previous government claims over many years that it is tackling child poverty. The UK has one of the highest poverty levels in the developed world. Poverty brings in its wake many problems of deprivation and reduced life chances, not least due to poorer health. It stands to reason, therefore, that we should be promoting breastfeeding among these most vulnerable families, for breast milk is ideal food, free to produce and use, and does not rely on profits made by formula manufacturers. Sadly, it is these low-income parents who are least likely to breastfeed, are more likely to have a poor diet themselves and more likely to use convenience foods of poor nutritional value.

While we have a number of supportive breastfeeding organisations within the UK, they are mainly accessed by the more privileged middle classes. That, in itself, is not a problem – support should be readily available to all who need it regardless of income – but this support is not perceived as accessible by the majority of mothers, perhaps because of its exclusive image, so inadvertent social exclusion is a part of it.

Breastfeeding, somehow, has to cross the social divide. It needs to be acceptable to the majority of people, not simply perceived and supported as a middle-class option, which suggests that high-level policy goals are still not hitting the spot and engaging younger, poorer mothers.

A Guardian article from 2013  about the work of Janet Wolf, a leading American critic of breastfeeding research methodologies, suggested that breastfeeding is all about reducing risk and that many of the so-called benefits of breastfeeding are probably due to other environmental factors largely relating to older, middle-class women. She mentions that women who “choose to go through the labour of breastfeeding have made a commitment to go the extra mile for the sake of their baby’s health. They are more likely to be doing other things too. Their homes are clean. They wash their hands. They will be reading more, talking more, serving more fruit and vegetables…”

In suggesting that it is hard to differentiate between the effects of breastfeeding and of generally high-level caring, Wolf makes the valid point that breastfeeding is not free if you count the cost of the mother’s labour. As with all parenting though, it is hard to put a cost on it, so it becomes a labour of love.

The material we read about mothers feeling guilty for not breastfeeding may also be questionable. The Journal of the Sociology of Health and Illness quoted that only 32% of formula feeding mothers feel a failure for not breastfeeding, and fewer worry about the effects on their baby’s health or what the health visitor will say, so we are maybe worrying unnecessarily about some sense of alienation. A huge 88% are just glad their babies are being fed. They have their own firm ideas of what is acceptable to them, which is good. Most people, at the end of the day, do what they think suits them best.

Historian, Christina Hardiman, author of Dream Babies, suggests that breastfeeding, like most other experiences/standpoints, goes through fashions. The more women work outside the home, the more breastfeeding drops. She feels that feeding comes down to women doing what they can in the circumstances in which they find themselves. And maybe that is exactly right, again, implying more individual agency than we might imagine. The question then relates to whether such women should simply be left to their own devices or offered more appropriate and targeted support. Part of the problem is deciding how far our choices are free or are externally constrained.

 

Breastfeeding is a natural “safety net” against the worst effects of poverty. If the child survives the first month of life (the most dangerous period of childhood) then for the next four months or so, exclusive breastfeeding goes a long way toward cancelling out the health difference between being born into poverty and being born into affluence…. It is almost as if breastfeeding takes the infant out of poverty for those first few months in order to give the child a fairer start in life and compensate for the injustice of the world into which it was born. ~James P. Grant

 

 

Chapter 7 – Negative culture (or what other people say…)

 

Susan, a nursery nurse, decided when she was pregnant to “give breastfeeding a go” as she felt that breast is best.

Those words themselves tell us a lot about the negative culture that surrounds breastfeeding. Women prepare to ‘give it a go’, with an underlying assumption of failure implicit in those very words. When Susan decided to ‘give it a go’ she hadn’t fully realised what she would encounter along the way.

I told my husband that if anything went wrong during the birth and I couldn’t hold the baby, or she was in special care for any reason, the staff must not give her a bottle. I didn’t want anything getting in the way of my being able to feed. It wasn’t plain sailing, as after delivery my blood pressure didn’t reduce, and Paige got jaundice. In hospital, they told me she would have to have bottles but I repeatedly said no. They sent a paediatrician to say if she didn’t have a bottle she would end up in special care. I finally agreed to let her have a little bit of milk from a cup so it wouldn’t interfere with the sucking action. I tried to express milk but it hadn’t come in yet. They used what little I had and topped up using the cup. Paige was fine and only needed a couple of feeds but I’m sure she would have also been fine if left alone.

Then staff monitored the feeding and said she was only feeding for ten minutes but needed to feed for at least twenty minutes. We were allowed out but two days later sent back in for the night because of the length of her feeds. I was told that I couldn’t say I was breastfeeding my baby if she was having only ten minutes. I can understand why so many mothers give up as I could so easily have given in then. It felt like if you couldn’t tell them how many ounces of milk the baby was getting, you had to give up. By day five, Paige had gained a couple of ounces. For my next baby, I wish to have a home delivery so I don’t get this kind of interference.

The whole tone of this mother’s story is that of being doubted, being asked to quantify something which is unquantifiable, and about fitting in with misconceptions about how babies should be fed; no doubt form-filling and ticking is boxes required.

Susan continued:

Paige is now almost one and I’m still feeding her. Most people supported me in this until she was about four months, then came comments about weaning her onto a bottle. In the end, I just said what I felt and that I was feeding her until she was a year old. That shut them all up, but now she’s one, it’s starting all over again. I love feeding Paige; I feel it has helped us to bond and we have a close relationship. It also helps as I now work full time and I miss her like crazy when I’m not with her. Luckily, I have the support of my Mum and Mum-in-law who bring Paige to me in my lunch hour when I feed her in the park and we play together. This routine started when Paige refused to take a bottle and today we can only get her to take three ounces of expressed milk. She won’t have any more and won’t take juice or water. She still never feeds for more than ten minutes and never did – it proves babies only take what they want.

Breastfeeding was brilliant until she cut her third tooth which hurt like mad. I thought about giving up but I couldn’t do it.  I never really had sore nipples or anything after the first few weeks until about a month after she grew teeth, when I had an abscess which cleared up with antibiotics. The only health professional who helped me was my excellent health visitor.

I experienced some negative feedback from a hospital doctor. Paige hadn’t gained the ‘correct’ weight. At first, the doctor was lovely but when he found I was breastfeeding, his attitude changed. He said I should give up and give her formula, that most babies have formula after six months. I said I felt babies should be breastfed for a year as it is better for their brain development, but he said “not if they’re not growing properly”. My health visitor told me to carry on breastfeeding as it was probably too late to introduce her to formula now; also, she’d get all the nutrients she needed from her other food as she has a healthy diet. Doctors need to be taught the importance of breastfeeding, so more women will succeed with it; we should not be given formula milk in hospital which makes a mother more likely to give up breastfeeding. Also, mothers need to be prepared for constant feeding in the early days because most women think they are not making enough milk if their baby feeds all the time.

That is an important point. Babies who are breastfed do it little and often, not four hourly.

Doreen is a midwife. She explains more of this negative culture succinctly:

I’ve never had a woman tell me she is going to try to bottle-feed but I have had many who tell me they are going to try to breastfeed.

Doreen is a grandmother, appalled at the treatment her own daughter received:

When her small daughter was born, she was only twenty and her little girl was diagnosed with severe heart abnormalities. Despite this, she breastfed her until she was almost three and Victoria (my daughter) was again pregnant. Initially, when Freya was a small baby, the breastfeeding was not a problem. As she got older there were some problems with people who did not think it was quite right to breastfeed a child. One occasion was after her second heart operation when the report was being given at the bottom of the bed and one nurse said: ‘She’s done nothing but breastfeed her since she came to the ward and why she needs to feed her at two, I don’t know’. This upset my daughter so much that we complained – the reply was that ‘cardiac babies don’t usually breastfeed’.

The very earliest comment was from a health visitor who decided that Freya was not putting on enough weight and told my daughter she would be better off with a bottle and that some women just couldn’t produce enough milk. At this we pointed out that the ‘failure’ to gain ‘enough ’weight was due to her heart problems and not a lactation problem. My daughter then breastfed her little boy. She said she would feed him until he didn’t want it an more and I admired her stance.

The advent of ‘follow-on’ milks and their advertising seems to suggest to mothers (and obviously doctors who are bombarded by the marketing ploys of companies) that babies over six months need something more than breast milk but as Susan realised with help from her health visitor, if other foods have been successfully introduced into a baby’s diet, then the marketing device of ‘follow-on’ formula is still not needed. However did babies survive before we had it? Advice to parents on feeding and other issues changes like the wind; with my first daughter, weaning at three months was common. By the time I had my third child, cow’s milk wasn’t advised until after twelve months due to allergy risks, but fromage frais and cheese (er, dairy products?) were considered fine! None of my five children has (fortunately) ever suffered food allergies whatever feeding practices I employed.

 

It often seems that we are letting baby milk manufacturers dictate the terms of our feeding, and health professionals sadly seem to be as readily taken in as the rest of us. How mothers feed their babies is their choice, but their choice should be informed, not merely led by the incessant force-feeding of information by formula milk promotion.nursing-2186615__340

When talking negative culture, if breastfeeding a young baby is tolerated, then feeding an older one is likely to meet with at least astonishment, but often incredulity, offensive comment and apoplexy, as many newspaper reports will testify. Melissa, the mother of Farah, explained:

As Farah is nearing walking, most people ask me when I’m going to stop. I simply answer them by saying that Farah and I will stop when we’re ready to stop. The issue for me now is that many people who think that breastfeeding is good also think it is unacceptable to continue feeding a baby who is growing into a toddler. But why should we stop now? We don’t have problems with it and it is keeping us both healthy and happy. My belief is that every child is an individual and each child will stop when they are ready for that step towards independence. Mothers shouldn’t stop just because society expects it.

As someone who finished feeding my fourth baby when he was two (my fifth at two and a half), at my own instigation following an extremely painful milk duct infection, I certainly noticed that people seemed relieved that I was once more socially acceptable. My son was not the nicest of feeders – he had always bitten and played with the nipple, making feeding often quite painful – so I was partly relieved to stop but also immensely sad – especially when he would touch my breast, saying: “Mummy’s milk – all gone” in a wistful way. He, at four, still remembered how he “loved Mummy’s milk”.

Some people accuse mothers who breastfeed toddlers of doing it for their own comfort, rather than the benefit of their babies. My answer is: if the baby enjoys and is soothed by it, too, then why not? Surely mothers who find breastfeeding beautiful, rewarding and part of the ongoing attachment process with their babies should not be denied such harmless pleasure. Of course, most mothers who breastfeed for any length of time enjoy it, otherwise, they wouldn’t do it. Many do not want the nuisance of sterilising bottles either. That doesn’t make it some form of aberrant sexual practice, so why does society view this as wrong? Well, we’re back to sex and innuendo, a belief that motherhood should be entirely about self-sacrifice rather than enjoyment, and that breasts are largely about sex. Breastfeeding is sensual, certainly, but not sexual and doesn’t have to be about maternal martyrdom. A revelation reiterated: it can be enjoyable – and often is.

 

Breastfeeding is a mother’s gift to herself, her baby and the earth. ~Pamela K. Wiggins

 

Chapter 8 – The input of others (or putting their two pennorth in!)

 

From America, Connie’s story shows the difference support from health professionals can make to successful breastfeeding:

I am the mother of a seven-year-old girl and an almost thirteen-month-old boy. I had a Caesarean section with my daughter, and between the pain of that and not having good breastfeeding support at the hospital, I was not successful nursing her. It was easier to give up. But I had my son in a different hospital that had wonderful and well-trained staff who helped in any way they could.

My son had some medical problems (at least they thought he did, but it turned out to be nothing) so we had to stay in hospital for five days. Because we had to stay so long, I learned much from my nurse who helped me with proper positioning and on how to get him latched on correctly so that it didn’t hurt when he nursed. On the day we left, my milk had come in, so at least I knew he was getting some. The first few weeks were still very hard. I had a good book to use as a reference for the basics. I fed him on demand and I woke him every few hours at night for the first month or so to make sure he was getting enough and to build and keep up my milk supply. I am lucky to be able to stay at home, so I didn’t have to worry about expressing milk to have a supply for a babysitter to feed him.

The only bad experience was that when he wasn’t gaining tons of weight, my mother- in – law would always say that maybe my milk wasn’t “strong enough” for him, her way of saying he would weigh more if he was drinking formula. His paediatrician is also a young mother of two who has breastfed her babies, so she was a big help and support. I don’t know how much longer I’ll be nursing because he is allergic to cow’s milk and anything made from it, including most formulas. All in all, I’m glad I nursed because I don’t think there’s a better way to feel so close to your baby. You have to feel comfortable in the first place if breastfeeding is going to be a success. And if you are married as I am, or live with your partner, then his support is critical.

America is often seen as a forerunner of behavioural trends, so the fate of breastfeeding there potentially has repercussions worldwide. ‘Bonding’ is beginning to be thought of as an old-fashioned term, yet a New Jersey Professor, Alicia Dermer, when questioned some years back, believed it to be one of the key benefits of breastfeeding:

Although bottle-feeding mothers bond with their babies, I believe there is a qualitative difference, and there are studies suggestive of a hormonal basis for this difference. Obviously, a bottle-feeding mother can work to do the things that come automatically with breastfeeding, such as close, skin to skin snuggling, prolonging the feelings and holding their baby throughout feeds, etc. But she is missing out on the oxytocin and prolactin surges which are part of the very intimacy of the breastfeeding relationship.

If separated from her baby, she doesnt have the constant reminder of her filling breasts and the hormonal milieu which keeps her physically connected’ with her baby and in fact, makes her need’ to be with the baby. Furthermore, breastfed babies are able to recognise their mothers smell by one week of age (a breastfed baby who has his own mothers milk soaked nursing pad and that of another mother placed next to him will turn to his own mothers smell 80% of the time). The implications of this phenomenon are hard to study, but bottle-fed babies dont recognise their mothers smell at all. One has to wonder what the severing of this very close physiological relationship can do to both mothers and babies.

 

Maternal benefits (or breastfeeding is pleasurable, but not everyone will thank you…)

There is almost an overload of information about how good breast milk is for babies, but breastfeeding is still often portrayed as difficult, unpleasant and smacking of martyrdom. Like anything else, it can be, but this is not, of course, the whole story.

As many mothers will testify, there are great advantages to mums from breastfeeding. It is often, as we have already stated, a sensual, enjoyable experience. Note, once again, we are not talking sexually here for those who like to assume that a woman derives some bizarre kind of sexual pleasure from it.

Melanie is the mother of Daisy who was totally breastfed until seven months when, due to peer pressure, Melanie introduced solids. Daisy didn’t really take to these until her first teeth came through at eight months and reached the dizzy heights of twenty pounds on pure breast milk, which gave Melanie a really good sense of achievement. She also breastfed her son, Oliver, for about two years, only stopping when pregnant again and struggling with bad morning sickness which seemed to be worsened by breastfeeding. It wasn’t totally plain sailing for Melanie who suffered from mastitis and a bitten nipple but she remains a big fan of breastfeeding and the benefits it has given not just her babies but her whole household. she gives a wonderful description of how endorphins have an impact:

Since having my second child, I found breastfeeding was essential to the wellbeing of the harmony of the house and all its members, for it helped to keep me calm.

Oliver was very upset by the birth of his sister, Daisy. Id planned a home birth but in the last weeks of pregnancy, Daisy remained transverse, so I needed a Caesarean birth. Oliver was not prepared for me to be in hospital, for I had never spent the night away from him. He was very traumatised by my absence which brought lots of bouts of crying as he tried to come to terms with all the changes. It was important to keep the equilibrium of the house positive and happy to avoid too many upsetting outbursts. I found breastfeeding a great help with this.

After one such crying incident, I decided to get the paints out and we all enjoyed a good painting session. Oliver (then aged 3) helpfully suggested he clean the brushes out at the sink, great as Daisy needed a feed. During a lovely long feed, I found breastfeeding hormones would give me a wonderful sense of calm and peace. I felt all dreamy and relaxed and it was clear Daisy did, too. This was all to the good when I returned to the kitchen. Oliver had decided to use the remaining paint on the brushes to paint inside the sink. To stop the paint being washed away hed swung the tap over the draining board and work top. Water had covered the work tops and was pouring onto the floor that resembled a swimming pool.

However, because I felt so relaxed from feeding Daisy, I simply burst out laughing – I couldnt believe hed created such a flood. He was totally oblivious to the water everywhere, so engrossed was he. We mopped up, but Im sure without the help of my breastfeeding hormones I would have reacted very differently and the situation could have blown up out of all proportion.

Lots of child care gurus advocate putting a baby asleep awake, with nothing in its mouth. Surely a mothers role is to ensure her childrens happiness for as much of their life as possible? What could be happier for your baby than to fall asleep after being fed or soothed at your breast, in the arms of the person who loves them most? I loved the expression on my babys face after she’d had a lovely, relaxing feed. Her cheeks seemed full and as she rolled off the nipple and settled in the crook of my arm, thick, creamy milk dribbled out of her mouth. She would slap her lips together and give a soft, satisfied sigh of contentment in her sleep. Its a special time, breastfeeding, that doesnt last long.

Betty, the mother of a seven-month-old boy, Gabriel,  was continuing to breastfeed. It is sad to read of the comments she received from other people, women especially, who should be more supportive of the choice to breastfeed.

I never really thought about breastfeeding until I got pregnant and even then it wasnt a major issue. I guess, this being my first baby, I thought the baby would automatically get fed. I didnt take the breastfeeding classes organised by the hospital and wish I had – it would have saved me the worries of some of the basic questions I had in the beginning. I had heard a lot about breastfeeding from health professionals and my family, and I went into hospital with my mind set. I was going to do it. Id seen my sister do it with her baby twelve years before and my nephew had grown up healthy, strong and extremely smart, so I wanted the best for my baby, too. My sister had also talked about that special bond between Mum and baby and I wanted that closeness with my baby. I also knew a lady who was a midwife – she really hounded me on the subject telling me that it is what God intended when he gave us boobs. I guess there were many factors and whichever one really motivated me, Im glad it did.

I really enjoy the closeness I share with my son every time we sit and I nurse him. I cannot get over the fact that I can provide nourishment for this infant – not only am I feeding him but I am also passing on all my love to him. Sometimes, I feel sorry for my husband because he cannot share that particular bond. I enjoy breastfeeding simply because I love my son.

Many people helped me to breastfeed – family members, lactation nurses, La Leche League representatives, friends, you name it. There was a lot of advice and encouragement and my sister helped me more than anyone. She would not only make me comfortable but showed me the correct positioning as taught to her by our grandmother. She made sure my cup of water was always filled. She helped with the baby because Id had a Caesarean section; she was just an angel. My mother made sure I had the right kind of foods. She made special dishes that her mother made when she had her babies specially made not to upset both our stomachs. Despite the help and encouragement, it was still a difficult journey.

I had many problems, starting with post-partum depression. My baby was born 6lbs 2oz and I blamed myself for this low birth weight. In my family, everyone has big babies and my hormones went wild thinking about that. I also had problems with the baby feeding very often – every hour – and I thought I was not producing enough, but my paediatrician just kept telling me to feed him on demand. It was a rough time but we gradually got into a more comfortable schedule. I never got cracked nipples or soreness – I would get engorged but it never caused severe problems – my baby was feeding so much and so often that he would never let me get that full. There were, however, lots of negative comments to contend with like:

That is so gross

Your boobs will drag down to your belly button because of breastfeeding

I prefer you to breast feed in another room

I really dont like looking at women breastfeeding

When they start talking, its time to stop that nonsense” and

You enjoy breastfeeding because it is sexually exciting for you.

I can only say to all Mums: feed on demand, keep at it – it will get easier – dont listen to negative people, seek professional help, take classes offered by hospitals, be prepared to give up your time and yourself for a while and include your husband in everything so he can be supportive.

Kristine is a practical woman but also one who is assertive and perhaps more radical than most in her approach to criticism.

I initially breastfed because it was free, but then I learned all the benefits from other women and will do it next time knowing beforehand that it is the best thing for my children. I got to spend time with my baby. I could hold him and look at him, sing to him and rock him, and tell him how much I love him. I didnt have to buy or mess with bottles or formula, so when he was hungry, I could meet his needs immediately.

My mother-in-law breastfed my husband when it was really uncool to do so and she encouraged me a lot. I now have a wonderful relationship with my son – we are incredibly close and I feel that I have given him something that nobody else could. Initially, I had some engorgement and one bad latch that led to soreness and blisters but I had a great lactation consultant, who helped a lot. We have had thrush a number of times. My doctor put us on nystatin which made my son sick, so my lactation consultant told me about gentian violet and how to use it, which worked wonders for us both.

Mothers should start off by saying I will– it prepares you mentally. Set goals – six weeks, say, then before you know it, a year has passed. Give breastfeeding at least six weeks. I hope mothers would get informed about what formula really is and the problems it causes. There is a lot of stuff on the internet – studies and information – that grossed me out. 

If a mother needs a pump, then get a good one and dont buy a formula company pump. Question doctors who tell you that you have to stop for whatever reason99% of the time it is rubbish. Supply your doctor with breastfeeding information – if they are good, they will appreciate it. Nap nurse with your baby or bring your baby to bed with you – it helps your milk supply and keeps the baby from having fore milk/hind milk imbalances. I dont let anyone tell me that‘ I need to do that in the bathroom. My favourite comeback is: ‘when you eat your lunch on the toilet, I will start feeding my child his lunch there. It shuts critics up.

Get a sling and use it – it is great to nurse and no one will know. Negative feedback from people immediately gets my guard up because they want to deprive my baby of food. Fortunately, it is only strangers who have been rude to me and I have been lucky enough to be confident to comeback at them. I got together a lot of information for my family when my son turned about a year about why you should breastfeed into toddlerhood and about child – led weaning. Fortunately, it worked. Had it not, I would have explained that this was my choice and I needed their love and support to do the best for my baby. 

The best way to tackle negativity is through education, by showing formula companies to be mainly interested in profit, that it is an inferior product which can be deadly in developing countries, that it often violates marketing codes, that it comes nowhere near breast milk because it is basically waste products. Then we can hopefully cut down on the profit margins of companies and get parents focused back on the needs of their child rather than the supposed ease of shoving a rubber nipple attached to a bottle full of waste products into their childs mouth.

An Australian mother described her experience, which reiterates the usefulness of having close family members who have breastfed:

I became pregnant with Molly when I was 31, and already knew I wanted to breastfeed. My husbands sister had already breastfed three children, so she was a great source on information and later on, support. While pregnant, I read a lot of literature about breastfeeding which confirmed our decision. I wanted to breastfeed for at least eighteen months, but by the time Molly was that old, I had already come over to the child – led weaning school of thought, and I just let her continue until she was ready to finish. She gave me no warning, just one night she refused to feed, and then the next night, and finally the third night I realised that she had weaned. I was devastated – no warning at all. 

I was pregnant at the time with Ethan, so perhaps it was hormones in the milk, and on reflection, it was nice having my breasts to myself for nine months. My Mum only breastfed me for six weeks, my next sister for nine months and the final two sisters not at all. I received opposition mostly from other mothers once I decided to breastfeed past one year. Their horror was amazing. I received great support from my husband, sister in law, mother in law and a girlfriend. I was often annoyed by women whose children still took a bottle to bed or had a dummy but felt that Molly should be weaned.

I breastfeed in front of men who are relatives or family friends, most of them having had children who were or are breastfed so are unfazed by it. All hospitals encourage breastfeeding as part of the WHO recommendations and health centre sisters are geared towards promoting breastfeeding. My health centre sister thinks the sun shines out of me, so I pity any poor Mum deciding to bottle-feed in her presence. My husband and brothers in law are all supportive of breastfeeding, but then their wives have all done it. I read somewhere that the number one reason in Australia for giving up (after physical difficulties) is that the womans partner wants her to stop and removes his support. It is very sad. I just believe in gentle parenting and breastfeeding; child – led weaning and having a family bed are all part of that. With Molly I was definitely shy about breastfeeding in public (except with family) but now, with Ethan, I breastfeed anywhere he needs me to. I am discreet, not because I think women should have to be, but because I dont like everyone to see my breasts.

It is often assumed that fathers find breastfeeding problematic because they are left out of the feeding process, yet supportive male figures hugely in the successful continuance of breastfeeding. Despite that, many men appear to find the subject difficult to deal with. While it is their problem and inhibition, it can and does affect women’s behaviour, because partners are significant.

Quoc is a British-born man of Chinese origin,  interviewed as the father of one child:

I do actually feel a little left out because I feel that I am missing out on the ultimate bond that can only be shared through breastfeeding. I participate greatly in Farahs care, but I want the baby to cuddle up to sleep with me and feel comforted by me as well as Melissas nipple. I see Melissa as motherly. I still enjoy sex but I see Melissas breasts as belonging to the baby.

Sex has lessened now, not because of loss of libido, but because the baby takes up too much of our time. I would rather that Melissa tends to the baby than gives attention to me. I dont feel any jealousy at all. I actually revel in the fact that Melissa dedicates so much of herself to the baby. I am extremely proud of her extended breastfeeding and I try to join in as much as possible, cuddling up with them when they settle down for a feed. I love Melissa in every mental and physical sense and if anything, I love her more since Farah has been born, for being such a wonderful mother to our child. I suppose I feel envious that the baby receives closer bonding from Melissa than she does from me, but I feel very proud that she is giving our baby the best gift. Breast milk is my babys favourite food and she should be able to have a meal whenever she desires. I will be the first to defend our rights as a breastfeeding family (in public).

My mother breastfed five of us, my younger brother until he was three years old. My older sisters didnt breastfeed but it has been encouraged in our family. Overall, the Chinese believe that natural is best, so inevitably, breastfeeding is greatly supported. It is also more evident in Chinese culture that young people value the advice and help of experienced elders more than young westerners do.

However, many young urban eastern women are being constantly influenced by pro-western traditions, especially fashion, and fashion is definitely more pro formula feeding than pro breastfeeding. My family was very supportive of Melissas choice to breastfeed Farah. If I had disapproved of breastfeeding, I believe Melisssa would have carried on regardless because she cares more about the babys health than other peoples views, but luckily, we are like-minded so it has worked out as the best thing for us all. However, she claims that I have helped in the sense that I supported her through the pain of sore nipples and engorgement while she was recovering from a Caesarean section. She says it would have been a lot more stressful without my love and support, although I do believe she would have coped as shes a very strong person.

Some men in western society have a macho mentality that makes them feel they must conform in every way society expects them to act, therefore joining in with society in viewing a womans breast as objects solely designed for (mans) sexual pleasure. However, the new man will hopefully start to phase out these old-fashioned, sexist views and we will hopefully see a complete turnaround in breastfeeding values in the future. The most positive thing we can do is act as role models for our young and let them see that breastfeeding is one of the most beautiful gifts that mother nature has awarded to the human race by being open and not embarrassed by the whole issue.

Everyone has a right to make their own decisions about how they will feed their children, but breastfeeding seems to be frowned upon more than bottle-feeding. Society needs to value breastfeeding more, which I believe will encourage many mothers to do it.

Contrast this to the view of Dave, an expectant father who takes an evolutionary biological and somewhat approach. His clinically-phrased comments suggest breastfeeding, especially in public, still has a way to go:

It would seem that the “primary and intended” use of anything would be the use that the object in question does most often, rather that which is done most consistently. When one thinks of the function of the breast (and I will use that broadly to refer to all parts of it), the process most consistently occurring would be sexual arousal. Secondly would be as a mating aid, as the visualisation of them serves as an attractant. Thirdly, would be as means of dispensing milk. Lactation is the process that the breasts do least over a lifetime, thus enforcing that this was NOT their intended use, but more of a “possible use”.

All processes throughout history have evolved – we humans have the instinct to attempt improving most things we have come into contact with. Hence, once we had technology for bottle-feeding, the process evolved.

Now, through the feminist movement and other‘ granola grass-roots endeavours, the process is regressing. Empowerment seems to equate acting with total disregard for common morality and decency. I feel that while breast milk may be optimum, the means of delivery should be restricted to pumping and then using a bottle. I find nursing to be disgusting and offensive. To each his own in private homes, but in public – discreet or not – it should be banned.

Breastfeeding is a choice, not a necessity. I am not questioning that it is “natural”- but that does not render it acceptable in public. The argument may exist that it “doesn’t hurt anyone” so what’s the problem? Well… if I were to stand next to this person nursing in public and watch or stare, would the woman have a problem with that? Why? It isn’t hurting anyone. My guess is the argument would be that it makes her uncomfortable to be watched by strangers. Well, having someone breastfeed in public makes a lot of people uncomfortable – so it should be treated the same way.

There are no errands that a mother has to run that would involve her having to be away from her baby so long as to miss a feed. Her husband should be running the errands. If no husband is in the picturewell, that’s the result of some poor planning and judgement that the public at large shouldn’t have to pay for.

My wife is due to have a baby and plans on breastfeeding. This has made me a nervous wreck as I am so angry she is choosing this option. I am fifty per cent responsible for this child, yet I have no say. It has already caused me to lose the desire to see her breasts, or go near them for that matter. It disgusts me to think my child will be sucking on them. It disgusts me to know that she intends on bathing with my child. It disgusts me that she wants her family in the delivery room. All of this has totally erased any physical attraction I ever had towards her and disheartens me that I have no voice in any of these matters.

While Dave’s view has been expressed rather more vehemently than we are used to, it is not that uncommon. And it needs addressing because this pathological dislike of breastfeeding is damaging but also not totally unusual. Many other men find public ‘displays’ of breastfeeding embarrassing, but why? And how much does male disapproval impact upon the family feeding choices? Significantly, it would seem. I wasn’t sure if Dave’s partner was fully aware of his pathological feelings but it looked like the road ahead would be bumpy.

My opinion is that anybody offended by breastfeeding is staring too hard. ~David Allen

Part of the problem is that material about breastfeeding is directed very much at women. most strategies rely on education and information which appeals to, at best, a relatively small social group. The support of fathers should be harnessed, too, with a move away from the ‘meals on heels’ sexualised culture to ensuring breastfeeding is valued for its own sake.

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Returning to work

One of the key reasons women give for stopping breastfeeding is returning to work. Groups like the Maternity Action and Baby Milk Action have campaigned to improve maternity leave for this very reason, to give mothers a chance to establish and continue breastfeeding before returning. Most mothers now engage in some kind of work outside the home and it’s true that trying to combine breastfeeding and work is difficult, but it can be done, as many mothers can relate.

Monica, despite initial problems, managed to overcome these, when she was interviewed:

I have been nursing my son, Guthrie, for almost nine months now. The first six months was full time. I was home for the first three months; this went well, but I did feel in the beginning that I could not get anything but nursing accomplished. I had a problem getting Guthrie to latch on correctly the first two weeks with resulting cracked nipples which was very uncomfortable – it even hurt to wear a nightgown. After we made it over that hurdle, all was well and I went back to work.

At work, I had to pump two times a day. I froze that milk and stocked my day care provider/our refrigerator full for the next three months. Pumping at work did become problematic at times because of meetings, schedules, lunches, etc. I generally pumped during lunch (for 30 minutes of the hour) and at 3pm or so each day (8oz a day total). It was difficult at times but having my own office and an understanding supervisor and co-workers helped. Im glad I stuck with it during the more frustrating weeks at work. Guthrie began to eat baby food at six months and required less breast milk. I decided to nurse in the morning, when I returned home at 6pm and before he went to bed at 9pm. This worked out well and I had no problems adjusting to the change in feeding schedule. I was sore for a couple of days and emotionally, it was hard to refrain from nursing him when I was at home, but my milk supply became smaller and so did my breasts.

I decided to breastfeed because of the health benefits for Guthrie. I am also a bit of a health nut, so I felt that was the best possible nourishment I could offer him. My Mum nursed me and felt it was a positive experience but she did not rave on about it. She thought I should at least try it. A work friend did nurse her son for the first six months and she was a great help, talking to me about her experience of pumping, engorgement, soreness – she even gave me a nursing bra shed never used. I also read a book about breastfeeding and working mothers.

Everyone has been really supportive but now Im beginning to hear:‘ Youre still breastfeeding?I plan to for at least a year and then will see what Guthrie needs. The teeth are a bit uncomfortable but like the sucking, I guess, Im getting used to the sensation. The best part is the cuddling you get to enjoy with your baby. After being away from Guthrie for over eight hours while at work, its especially nice to hold him and enjoy the time together. Id advise all mothers to stick with it through the tough times, to buy a good pump, talk to positive people, and especially to have a sense of humour (especially when your favourite clothes are too tight in the bust, or when you leak at work or during sex).

 

 

[Bottle feeding] also made a fetish out of cleanliness, and maybe all the washing and scrubbing has further reduced the pleasure we take in our body and in life. ~Author Unknown

 

A primary role of the father is to teach the baby that love and comfort are not necessarily associated with food. ~Author Unknown

 

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Chapter 9 – Drowning in disapproval

 

Kerry explains how mothers quickly conform to the expectations of other people’s disapproval. Sometimes it is explicit, other times more subtle, but either way, it has a psychological impact. Bottle-feeding mothers feel it, too.  The upshot is that it is surely time to stop telling mothers how to feed their babies but to ensure that those who wish to breastfeed get appropriate support and a fair crack at it.

Recently, a friend unexpectedly became pregnant with her second child. She began asking me a lot of questions about breastfeeding. She started to nurse her first child but got little good information and tons of disapproval from her in-laws. She began giving him formula and said it was just easier than sneaking in her nursing while they were on a family vacation.

With my first baby, I didnt understand the importance of latching on properly and it was painful. I cried all night and said I would switch to formula but I stuck with it and after a long chat with a sweet lactation consultant, I figured out what we needed to do. After a few hours, I was pain free and enjoyed cuddling and nursing my son. I nursed him until he was seventeen months old. My second child latched on with no trouble. By this time, I talked to enough people who knew what they were talking about and put my daughter to the breast minutes after her birth. My son did not nurse for many hours after his birth because no one told me and I didnt know any better. My little girl and I snuggled and nursed all night her first night. It is a very warm memory for me, such a loving introduction to each other. My daughter is two years old now and still nurses a few times a day. We have eliminated her night feeds by making the rule that she may not havemilkiesuntil the sun is up. She adjusted to this with surprising ease.

By the time my friend gave birth to a daughter, I had talked her into breastfeeding no matter what anyone said. I spouted off some facts about immunity and the seemingly magic ability of human milk to create antibodies as needed, but I think it was my personal stories of closeness and benefit to the family which won her over.

Rachel is a midwife and breastfeeding counsellor trained in Norway. She explains why she feels the Norwegians have been so successful in promoting breastfeeding.

Breastfeeding rates in Norway are very high, but midwives and other health professionals cannot claim credit for it; the main initiative came from mothers, whose efforts only paid off after many years in the form of more breastfeeding compatible routines in hospitals.

Now we have long maternity leave with pay, no advertising of breast milk substitutes and a culture which tolerates nudity in most contexts with very little fuss. Most new mothers were breastfed themselves, at least for a time, and that also helps. I feel threats to breastfeeding seem to have a frighteningly rapid effect, while efforts to protect, promote and support breastfeeding seem to need a longer perspective.

Still, women choose to breastfeed if given a real choice, and it takes surprisingly little effort to maintain their motivation. This has helped me to maintain my conviction that breastfeeding is a process designed for survival and designed to survive. The change will come.

As Rachel points out, the laws protecting breastfeeding in Norway are comprehensive but also society is more affluent than in many countries.

Here, most mothers are articulate, educated members of the middle classes. Yes, the affluence of Norwegian society plays a part. Virtually no woman is forced for economic reasons to leave her baby, and all women receive the same antenatal care at no cost to them. It is nearly impossible here to fall through the cracks and that helps breastfeeding.

The Scandinavian countries are often held up as a fine example of breastfeeding awareness, so how does this compare to other countries? Obviously, there are big differences between USA/UK and Norway, accounted for by legislation, but also by culture. Nora is a social worker in Japan, specialising in pregnancy, birth and parenting issues. Here too, breastfeeding is promoted:

Here the nurses almost force you to breastfeed and you have no real choice. They very much stress the importance of the first milk. Mothers also believe that if they dont breastfeed they almost fail as mothers but those who cannot breastfeed receive encouraging words from other mothers.

It is believed here that breast massage helps to encourage the milk to come in but this is not true – I think letting the baby suck promotes milk flow best. Nurses here are trained in breast massage – they bring a hot towel and put it on the breast and start breast massage on the bed to help the blood to circulate to help milk supply.

 

 

Health problems

For women with longstanding health conditions or disabilities, there may be other challenges to breastfeeding, which requires some understanding of the impact of the condition upon the mother and a need for support enabling her to breastfeed if she so chooses. There are many health conditions which make breastfeeding more difficult, but not impossible. Chris, a myalgic encephalitis sufferer, successfully breastfed.

When I discovered I was pregnant, I was determined to give breastfeeding a go. My son, then aged fourteen, was bottle fed, as I didnt fancy the idea back then and there wasnt much support or encouragement around.

This time, I had a close friend who was very pro breastfeeding – she said she would support and encourage me with any problems I might encounter. My other concern was whether the ME would affect the breastfeeding. Charlotte was delivered by emergency section on New Years Eve. The midwives placed her on the breast while I was still in the recovery room and she fed for a good ten minutes. The next day, I transferred to the midwife-led unit where Id originally planned to have Charlotte – the midwives there were absolutely fantastic. I almost had a midwife to myself and received unlimited encouragement and advice, suggestions, etc. By the time I got home I was confident that I could give breastfeeding a real go.

It took us about six weeks to get into a nice routine, even if that was feeding every two hours during the day. I was even able to express some milk for a week or two so that hubby could do the odd feed but had to give that up because she was such a hungry baby and I didnt seem to have enough. We supplemented her feeds with a daily bottle of ready-made formula until she went on solids. At nearly twenty weeks, on three to four baby meals a day, she was still breastfeeding.

My GP advised me to stop breastfeeding because I was losing too much muscle which was not helping the recovery of my ME relapse.

My general feelings about breastfeeding are very positive. I have found it worth the perseverance despite episodes of sore breasts, nipples and engorgement. Ive felt that it has helped me to bond better with Charlotte as it is a very exclusive part of the mum-baby relationship and I like the bit where you get the bug-eyed look and a satisfied smile from her with a full tummy. I was disappointed to have to give up but it was important that I regained some strength as she grew more demanding. She had the best start I could give her.

Later contact with Chris elicited more information:

My GP isnt keen on breastfeeding after three months, so I knew Id have an uphill battle with him. My health visitor was initially supportive of me but spoke to my GP who was still on the opinion that I should stop so he could put me on Prozac which is supposed to be good for ME.

I had lots of contact with ME groups, the NCT and La Leche League to see if they had heard of breastfeeding causing muscle wastage alongside general weight loss. The answer was, of course, no.

It seems that GPs are very keen on stopping breastfeeding if there is a problem like a relapse of ME or if someone has an operation or some other health problem after birth. I decided not to stop – at least it was something good I could do for Charlotte despite my other limitations. If medication had a cast iron guarantee of improving my ME, then I might have considered it, but most treatment is hit and miss, trial and error – once youve stopped breastfeeding, thats it. I didnt want to feel as if I was being pressurised into treatment I didnt really want.

Why dont women breastfeed for long?

 

Concern for the decreasing incidence of breastfeeding within weeks is not new and it is evident that a number of factors interplay. Not wishing to generalise but sometimes having to, various studies have shown that a high proportion of those mothers who choose bottle-feeding come from lower socioeconomic groups with associated limited educational experience. These mothers tend to be younger when having their first babies, are likely to have been bottle-fed themselves and are unlikely to have a close relative who encourages them to breastfeed.

Embarrassment is cited as a reason for not breastfeeding and it does seem that breastfeeding is perceived more as a private event with some women embarrassed to feed in front of others; this, in turn, makes bottle-feeding more of a social event which attracts a level of status and attention. No one becomes embarrassed to see a mother bottle-feeding her baby, yet people will be when they see a mother breastfeeding, even if the breast is covered.

There are also online forums where women will mention that they find breastfeeding disgusting because they cannot differentiate the sexual use of breasts from the feeding function. Yet, while breastfeeding mothers will feel may things, I’ve never known one who says it is a sexual experience for her. I guess it is equally questionable why we push babies out of our vaginas, which are also used for sex.

Many people have issues with breastfeeding and sex. Some men – and women –  feel that breasts become taboo during feeding. Some women feel sexier and more sensual when breastfeeding. Some men like the taste of the milk which is apparently very sweet, like melted ice cream. Others may not. Ultimately, people’s sexuality is up to them. We all have different views of what we feel comfortable with, and libido fluctuations will also play a part. Breastfeeding or not, babies tire you out! The reality is that we can, luckily, use our bodies for many things equally well, and one does not necessarily negate the other. What happens in the bedroom stays in the bedroom.

One interesting piece of research is an elderly study by Richards & Bernal (1972) which suggested that bottle-feeding mothers have longer gaps between children than breastfeeding mothers. This has led them to suggest that those who bottle-feed may have a lower fertility rate (nature steering the fertile towards breastfeeding as a natural contraceptive) or have intercourse less frequently. So, sensuality, sexuality and breastfeeding may all be linked with a feeling of being comfortable with our bodies. Are breastfeeding mothers more comfortable in their own skin? Who knows. It’s an interesting idea though.

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Jana, a mother of eight, a childbirth educator and lactation consultant from the States, picks up on the sexual breast issues:

We are in love with breasts as sexual organs, and bottles as cute little things you give babies. Somehow, we have a hard time reconciling those sexual breasts that we see on television with the motherly breasts that nourish our young. We are trying hard to separate the organs used in sex (that is so much fun) with the same organs used in birth (that we must control) by medicalising it. Also, women try’ to breastfeed, the same way they also try’ not to use drugs in labour. I dont hear many women say firmly: “I am going to breastfeed this baby”.

Philosophies differ, too. Some people feel that breastfeeding limits women. Others feel that breastfeeding is a biological right for women, but for those who want to breastfeed, the advice given has traditionally been poor; for example, advice to feed every four hours relates to bottle-feeding. Babies feeding more regularly are interpreted as hungry’ and the mother is seen as ‘not having enough’ milk. Her confidence seeps away. The sight of a distraught mother whose baby is screaming with hunger because four-hourly feeds have been advised is not a pleasant one.

Jana feels that a lot of doctors aren’t very supportive, whether it’s because they don’t have a good, working knowledge of breastfeeding, they believe that formula is nearly as good (because the formula sales reps tell them that), or because they don’t want mothers to feel guilty. Additionally, children rarely see a breastfeeding role model these days, as family size has decreased and mothers mainly bottle-feed. Jana explained her own role model:

My mother is in her 80s. She was breastfed, as were her nine brothers and sisters.

She breastfed my older brother and sister and me, too. I was born in 1953 when breastfeeding was not the thing. Her doctor told her it wasnt a good thing to do and wrote out a formula for her to give me. God bless my passive-aggressive mother. She just stuck the piece of paper in my baby book and breastfed me. She probably lied to the doctor.

The formula? Sweetened condensed milk and Karo syrup. Pretty damned scientific. I am disgustingly healthy, with nice straight teeth, as are my brother and sister. My children are very healthy, too. We expect to live nice, long healthy lives as did my grandfather (dead at 100 in his sleep) and his mother (dead at 99 in her sleep). I came from immigrant Northern Italian and Sicilian stock. Peasants. For them, breastfeeding was the only way to guarantee your children would live.

In a modern consumer society, the attack on mother-child eroticism took its total form; breastfeeding was proscribed and the breasts reserved for the husband’s fetishistic delectation. At the same time, babies were segregated, put into cold beds alone and not picked up if they cried. ~Germaine Greer

 

 

Chapter 10 – Is breastfeeding a feminist issue?

Sadly, in the UK, feminism has dramatically dropped off the political agenda and the F-word is now something from which many people, including women, disassociate themselves, yet in the US, feminism, advocating equality and women’s rights, is still an active movement as the many social media groups will testify. Feminist magazines have left the British newsstands but Ms and similar are still alive and kicking in the USA.

One of the points many women make is that they opted for the bottle because breastfeeding was too tying. Having achieved some degree of workplace liberation, they feel that to tie themselves to the sole care of a young baby flies in the face of equality. Other feminists feel that motherhood – and breastfeeding –  is empowering, something which only women can do. Many mothers won’t be remotely interested in feminism and academic argument but for those who are, the question is a fascinating one and one I posed to readers of a midwifery website. Many tabloid columnists feel that breastfeeding means ‘giving up a woman’s freedom to work and play’.

Some years ago, I peeked at Debrett’s Guide as an indicator of‘ correct’behaviour. Sadly, John Morgan, author of Debrett’s before his premature death in 2000 was of the ‘anti’ school.  In his book, he compared breastfeeding to urinating or defaecating in public, when he wrote: “It is bad manners to expel any liquid from any orifice in public and breastfeeding is no different”.

It was mentioned as one of the social ‘no no’s’ alongside eating corn on the cob and discussing one’s change of sexual orientation at the dinner table. He mentioned that public breastfeeding was not widespread. Well, he was right on one thing – but then breastfeeding at all is not widespread in this culture of ours – and not surprising, perhaps, if a woman wishing to leave the home with her baby is seen as a social pariah if she discreetly feeds her infant.

Thankfully, Mr Morgan offered us the reason for breastfeeding to be such a social faux pas. It “is largely due to the fact that many onlookers find the sight embarrassing, even revolting”. He classified breastfeeding in public as “selfish aggressiveness”, something mothers are, of course, renowned for the world over. Mothers are damned whatever they do – breastfeeding is widely acknowledged as best, but mothers are to be incarcerated in their homes with their infants (how handy, men) because breastfeeding in public is “bad manners”.  Or they are to go to shoddy mother and baby rooms and feed in what is effectively a toilet. Or they allow their babies to scream with hunger, but presumably, that would also be bad manners? But really, perhaps mothers should not be entering the public domain with their babies anyway. Let them take the holy veil, and stay in the domestic sphere, along with their toy dinosaurs.

Some men do seem to have really bizarre ways of thinking about breastfeeding.

In defending his views on manners, Morgan added: “mothers do have to remember that for many people, especially the older generation, the sight of a woman breastfeeding is rather distasteful”. I beg to differ. Not all, but many of the ‘older generation’ are far more likely to be familiar with breastfeeding and are likely to understand the real needs of babies. I have rarely received any adverse comments from older people about breastfeeding. Finally, “good manners are all about what is offensive to other people. If something is considered offensive, people should not do it in public”. This is right in principle, so out go garish ties, wobbly fat bits and beer guts hanging over low slung trousers,  mobile phones, petrol fumes from cars, eating fast food, kissing, regional accents, Scouse brows, Speedos, and anything anyone else may find remotely offensive.

Such responses, albeit largely outdated, smack of misogyny on the one hand and confusion on the other. Sexual breasts, online or in print, or even in public,  are OK, but biological breasts are not. Motherhood has to be clean and Madonna-like in its manifestation. Women, it seems, are supposed to keep their leaking to themselves whether it be breastfeeding, menstruating or a touch of urinary incontinence. Men, meanwhile, continue to pee unabated at the side of public highways – not, incidentally, mentioned as bad manners by Morgan.

Of course, even Debrett’s has moved on a little. More recent advice:

New mothers are encouraged to breastfeed for a minimum of six months but may find that attitudes to breastfeeding in public, or in the workplace, are censorious and off-putting. Negotiating this minefield requires sensitivity and flexibility.

While as a mother you may feel that you have an absolute right to breastfeed wherever you choose, you will probably find you have an easier time if you are not aggressive about your rights, and remember that some people (especially the older generation) are uncomfortable about the whole issue. It is possible to breastfeed discreetly, using specially adapted clothing, scarves or shawls to minimise self-exposure. It is also possible to choose locations that are a little out of the public eye.

If a mother has made an effort to breastfeed discreetly, she deserves to be treated with tact and sensitivity. Do not stare, or pass comment, or give her disapproving looks. She has made concessions to you; now you must reciprocate.

No danger of a feminist infiltration at Debrett’s then.

Jana had some thoughts of her own about feminism:

I dont want to compete with men – what would be the point to that? We are separate but equal, fascinating in our differences. We see things differently, we think differently. Motherhood is empowering. In the 1950s, I was raised by a mother who didnt work outside the home. She was always there when I came home and was a lot older than everyone elses Mum. I was born when she was 38, pretty weird for the 50s. She taught me to read before I went to school, gave me a good working knowledge of right and wrong, and also gave me some mixed messages about women. But I always thought it was great to have a choice – having a career, having a family, staying home, mixing both or doing anything else a woman wanted.

But women need to be told the truth and make their decisions from there. They should have a choice to do what is best for them, their children, their families and their lives. For me, giving up a few things while I was breastfeeding wasnt a hardship. I see the benefits of extended breastfeeding in the health of my children and the close relationship we enjoy.

Ive seen women not breastfeed because they feel they cant leave the baby whenever they want – one friend chose not to breast feed because she wanted to take a trip with her husband when her baby was two weeks old. That was her choice. That child now has lots of allergies and ear infections, ending up with grommets before the age of two. The second baby was the same story. With her third, she did a little breastfeeding but found it interfered with her life and was embarrassing. She did it mainly for health benefits.

Another friend pumped and breastfed for three years because of an allergy history in her family. She had Caesarean sections with all four children and with the last two went back to work at six weeks post partum. She had the worlds worst breast pump that shed bought at a garage sale, but she didnt find any of it a hardship because she felt she was investing in her childrens future.

Another contributor, Heather, feels that:

Breastfeeding is a political act, a feminist act, and very empowering. It is also an anti-capitalist act. I was a socialist and a feminist long before I was a mother and politically, it would not have occurred to me to feed any other way – what? Line the pockets of the multinationals? Not me! It also fits in with my ideas of myself as a mother, and of course, it is a lovely thing to do.

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The way we were

Were we ever a fully breastfeeding nation? Well, the obvious and simple answer is ‘no’ but the decline in recent years deserves some investigation. Brenda’s account offers insight into the experiences of breastfeeding mothers sixty years ago:

I have happy memories of breastfeeding, having married at 38 and having my son sixteen months later. While attending clinic, I was asked if I was going to breastfeed and when I said yes, the nurse advised me to express my nipples now and again to release a clear liquid, colostrum. I had a Caesarean section and my nine and a half pound son was taken to the premature baby unit, so I didnt have him with me for the first couple of days. However, the doctor and ward sister visited me to ask if I wanted to feed him.

As Id not done it immediately, I thought he would have become used to the bottle, but they assured me it would be alright, so when he was put to the breast, he sucked happily with no problems. Of all the mothers in the big ward, only one young girl was persuaded to try but she experienced difficulty with sore nipples. She persevered while in hospital but gave up as soon as she went home. I felt the earlier advice to express my nipples helped me.

For me, it was an incredible experience, a wonderful bonding. It was completely free – I dont know how many boxes of baby milk I saved. Also, I dreaded making up bottles with powdered milk. I find difficulty making custard, etc., which invariably turns out lumpy, and I worried about temperature. Breast milk, thankfully, is free from lumps and the right temperature all the time. During the night was so easy, too – lift from cot beside bed, feed, wind, return – no making up bottles or warming them. Going out meant nothing to prepare or take.

As a child, I had every childhood ailment, but my son had none at all. However, I was breastfed, too, but immunisation in those days was only for smallpox. There were disadvantages – I was never sure how much milk my son was getting but obviously he stopped sucking when satisfied and gained weight.

At home, it was unsettling and I seemed to be feeding every hour at first but a nurse had warned me of this, so I persevered and things improved. I fitted in whatever I did around my feeding, so never left him for any length of time. Also, my son didnt have regular motions but I was assured it was because there was little waste from the nourishment he was getting. I continued to feed for four months but suddenly he went completely off me and had screaming fits.

A health visitor suggested that if I decided to give up that I use Carnation milk, diluted. This he accepted as a substitute for my milk. I blamed his rejection on my taking the pill. I hadnt used contraception before but on the advice of someone who visited everyone in the hospital and because I was rather tired with my new life of motherhood at my age, I took the pill. I wonder if it affected my milk. At the time, I was upset at not being able to continue but I had four satisfying months when he was solely dependent on my milk. The Carnation milk was easy to prepare and he soon progressed to cows milk and solids.

I love the honest phrase ‘rather tired with my new life of motherhood’!

Not all women have such happy memories, nor such early support. Sally tells how twenty years or so ago, staff methods of encouraging mothers to breastfeed adversely affected her:

I believed first time round that breast was best because it was pushed at me throughout my pregnancy. Because I didnt know any better, I went along with it but after giving birth to my son, my nipples were inverted, so I couldnt feed him. I was prodded and poked until I was sore and Kevin was screaming for a feed, which upset me.

It was a girl in the next bed onto her fifth child who told me to tell them to stop and put my baby on a bottle. I did this and never looked back. When I later gave birth to twins, I was again railroaded towards breastfeeding but it was never in the frame. My nipples were fine this time, but with two babies and a three year old toddler, I wasnt going to be tied. Looking back, I wouldnt change anything. Mothers should not be influenced towards a breastfeeding option but given the facts and left to make up their own minds. Bottle-Feeding is the best thing I did and it is not embarrassing in public.

With the greatest of respect for Sally, who was obviously not encouraged to try breastfeeding but was rather bullied into it, the story is a sad one. In developing such negative personal feelings about breastfeeding, Sally is highly unlikely to recommend it to any younger woman who may ask her about it. Often, it is support from other family members, especially mothers, which is crucial in encouraging breastfeeding. My own mother’s alleged inverted nipples meant I was not breastfed, though my approach to life was to do whatever my mother didn’t! Her nipples looked perfectly fine to me, so were the ‘inverted nipples’ of yesterday the equivalent of ‘insufficient milk’ that women suffer today?

Thanks must go to my mother-in-law, an educated woman, for providing me with information which she used as a mother back in 1952. What is worrying is that she found herself in exactly the same situation as many young mothers do today. Socially and geographically mobile, it is easy to become isolated, relying heavily on books and magazines for information. These, even today, cover breastfeeding in a very disappointing way, either by paying little attention to it or by focusing on the problems. Any magazine article on feeding choices (and I’ve written plenty of them) has to outline both breast and bottle equally, so as not to make bottle-feeding mothers feel guilty. As a freelance journalist, I sold a number of features on resolving breastfeeding problems, but none simply advocating the joy of breastfeeding.

In the early 1950s, Dorothy’s son’s complementary feed was made up of half milk, half water and 5 teaspoons of sugar. At eleven and a half weeks old, on a bottle only, the daily ration was 22oz milk, 18oz water and 7.5 tsp. sugar.

By thirteen weeks, I was following Nursery World advice and using barley water in an effort to stop Nick being sick. It gradually improved and he began to gain weight steadily. By fourteen weeks, he was on (daily) 25 oz milk, 15 oz barley water, 3 tablespoons sugar, a small teaspoon Marmite and a few drops of Adexolin (vitamins A &D). I made up the days feed and kept it in the fridge. The bottles lived in Milton solution in a covered container. The milk was ordinary doorstep, not Jersey. Quite a concoction.

Gabrielle Palmer mentions in passing in her classic book, The Politics of Breastfeeding, the seventeenth-century orphan who was raised on beer and lived to be seventy.

Children, it seems, can survive many things. Interestingly, health visitors today would hold their hands up in horror at salt in the milk (kidney impairment), sugar (dental decay and obesity) and cow’s milk (allergies and intolerance) yet it seems that when advised to do so, mothers would make up their own formula, and babies somehow thrived on it.

When we trust the makers of baby formula more than we do our own ability to nourish our babies, we lose a chance to claim an aspect of our power as women. Thinking that baby formula is as good as breast milk is believing that thirty years of technology is superior to three million years of nature’s evolution. Countless women have regained trust in their bodies through nursing their children, even if they weren’t sure at first that they could do it. It is an act of female power, and I think of it as feminism in its purest form. ~Christine Northrup

 

 

Chapter 11 – Extended breastfeeding

It is difficult to decide exactly what constitutes extended breastfeeding; for some, it may be anything over three days, one week or six weeks. Many see six months or one year as the magical stopping time. Yet many mothers continue to feed their toddlers until a mutual decision is made to stop. My own father was breastfed until he was three years of age in the late 1920s/early 1930s. Often, health professionals equate weaning onto solid food (usually at around four months but recommended at six months by the World Health Organisation) with stopping breastfeeding and some mothers have been told to abruptly stop, leaving them open to problems of engorgement and to a distressed child and mother. Many mothers continue to breastfeed once their baby is taking solids but few breastfeed an older child in public. Society finds this very difficult to cope with and mothers often feel they must be secretive about the social taboo of continued feeding.

With commentators putting the boot in against breastfeeding mothers, it is little wonder that public opinion remains so confused about the messages that are given off by breastfeeding.

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Journalist Julie Burchill, for example, once wrote about women who find breastfeeding (heaven forbid) pleasurable: “This is a bit pervy; the place for sensual pleasure is with a consenting adult not with someone who keeps wetting themselves”, an extraordinary statement which confuses sensuality with sexuality. And how sad that she seems to have denied herself any such innocent pleasure.

She also unhelpfully compared women who breastfeed in public with men who expose themselves, which sounded like Debrett’s all over again. The one useful point she did manage to make was that “those who do not suit breastfeeding should not be made to feel guilty or failures; this more than anything will get their relationship with their babies off to an extremely bad start” which smacked as a cry from the heart.

There are many myths about breastfeeding capabilities and it often takes a strong woman to counter these. Dianne is one such woman:

I was adamant from the start that I wanted to breastfeed Patrick. I got off to a very bad start in hospital where I was not given much help on the first evening and got very sore because he wasnt latched on properly. The pain was very bad for a long time – Im told it was because I have fair skin and red hair!

Then I got mastitis when he was about a month old and because it wasnt treated properly, it turned into a severe abscess. I had to go into hospital to have it drained and needed five weeks off work to recover. I persevered and when Patrick was four months old, I returned to work full time. I still fed him because the nursery he attended for the first month was close enough for me to go and feed him in my lunch hour and thereafter, I went home every lunch time to express milk, using an electric pump hired from the local health centre. When he returned to nursery at the age of nine months, I fed him at nursery again and continued this feed until his first birthday when he moved out of the baby room.

He is now two and a half and Im still feeding him in the night when he wakes, first thing in the morning and last thing at night. He still wants a feed most nights when we get home from work although that is lessening now. He shows no signs of wanting to give up as he says it is better than milk, orange juice and even Ribena! I do try to insist that we only feed in private now as most people think I am very strange to carry on this long. Im really glad that I stuck at it. I am convinced it is better for the baby and also, in many cases, for the parents. I feel that we have established a great bond between us that should last throughout childhood. But mothers need a more positive message along with help and support from hospitals. Were it not for my innate stubbornness, I may have given up.

Another mother, Rebecca, added:

I think I breast fed partly because my mother breastfed. I probably would have done it anyway, but the fact that I grew up thinking thats what your breasts were meant for meant that it never occurred to me to consider an alternative.

My partner was not breast fed – however, his mother breastfed his siblings and would have liked to have breast fed him but was told she was too old to breast feed when she had him. Again, he didnt consider any alternative when we had a baby – he assumed I would breast feed.

I didnt plan to breast feed for so long, but I was one of those rare people who didnt feel negative about extended breastfeeding. I always planned to breast feed from childhood, but first came across the concept of extended breastfeeding as a student nurse. A two year old girl who had just had an operation kept asking for Mummys milk and nobody knew what it was at first. When we found out, I remember that everybody seemed shocked and disgusted but I couldnt understand why. When I had my son, I planned to feed him for at least a year but he wasnt terribly interested in solid food and there seemed no reason to stop. He will be four soon and I do occasionally wonder if I should stop but I still cant think of any good reasons.

My main worry is that it will be misconstrued – I try to keep it quiet, especially at work. I work full time and spend a lot of my time travelling and studying. Breastfeeding continues to be a way in which my relationship with my son is special and almost seems more important now that I see so little of him. Nutritionally, Im sure it does still have some benefit – he doesnt drink cows milk.

My experiences have generally been good. I had no problems from the start – he latched on from birth, no engorgement, mastitis, pain, nothing. I breastfed in public often and only ever had encouraging comments from strangers. My lack of negative experiences is perhaps another reason Ive kept going. I didnt feel very good when I was pregnant and the change after the birth was dramatic. I felt so content and calm. It seemed as if the levels of hormones associated with breastfeeding suited me. I am also a single mother – my sons father left when he was one year old. Im not particularly young and Im not sure Ill ever have another child, so maybe knowing that when I stop it will probably be forever makes me reluctant.

The benefits for my son are the special relationship, the ease of comfort, the security, and the possible nutritional and immunological benefits. I dont think there are disadvantages for him. He is affectionate but not clingy and not a mummys boy. It doesnt seem to make him over dependent. He nurses to sleep but goes to sleep without if Im not available. He can be comforted by other people. Breastfeeding is an extra thing he has with me – it doesnt get in the way of his relationships with other people or stop him going out into the world. The only thing that bothers me is whether its bad for his teeth to be nursing last thing at night. For me, it enhances my relationship as a mother, makes me feel special and is often a tender and enjoyable experience. I think benefits like this are often under-emphasised but why shouldnt a mothers feelings be important, too? Just as I wouldnt disapprove of a mother who stops breastfeeding because she doesnt enjoy the experience, she shouldnt disapprove of me for continuing because I do enjoy it.

 

Kristen explains the joy of breastfeeding as she discovered it:

I simply loved breastfeeding from the start. The most poignant memory I have is the moment when my son, looking up at me while feeding, gave me a huge, gummy, toothless grin without ever letting go of his latch, then continued to feed. What joy! Breastfeeding was incredibly easy and convenient for me. No big bags full of bottles, formula, heating devices – I had the perfect food, always ready, always at the right temperature, in the necessary amount. I later breastfed my daughter until she was over two years old. I did get some pressure from family and friends that she was too old to continue breastfeeding. I honestly cant understand why anyone would want to feed any other way. My son I fed until nine months when I returned to work. He later was found to have coeliac disease and I wished I had not given up breastfeeding so soon as he had to go on an extremely expensive, pre-digested formula.

 

Do not nurse a kid who wears braces. ~Author Unknown, “Nursing Mother Principle”.

 

 

 

 

Not Enough Milk? What about twins and more?

Twins and triplets occur more readily with the development of fertility treatments like IVF. In a culture which recognises ‘inadequate milk supply’ as a problem quickly resolved by the adoption of formula feeding, mothers of multiples are under increasing pressure not to breastfeed. Certainly, the almost continuous nature of such feeding has to be more wearing, but it is certainly possible. Feeding twins is forever linked in my mind with the dreadful but effective image used by IBFAN and Baby Milk Action of the Asian mother of twins, a boy and a girl, told she wouldn’t have enough milk to feed both babies herself. The picture shows a healthy boy at the breast and a withered, shrivelled, malnourished and dehydrated daughter on the bottle–the daughter later died. Feeding methods may not be such a matter of life and death in the developed world, but in many countries, access to the breast offers the greatest chance of survival to some of the world’s poorest children. Breastfeeding in the west reduces the profits of baby milk companies, playing no part in the sometimes questionable marketing methods used in the developing world.

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Wanda is a mother of twin boys, conceived naturally. They have been successfully breastfed during the early months of their lives. Wanda explained how she made her feeding choices:

Our twins class at the hospital recommended the V-shaped cushion for feeding both twins together. My husband took this on board and set out to find one but it was very difficult to get hold of one in London. They also recommended a good book on breastfeeding but I felt I had enough support from my sister, the midwives, the feeding specialist at the hospital and La Leche League.

My mum told me that relaxing is the key to breastfeeding. Her sister-in-law never managed it, but she was a high energy, hyperactive sort of person. My mother-in-law tried it with each of her three but found she was sitting on a sofa with a sleeping, half-fed baby wondering whether to wake him up to finish as he hadnt taken enough, and at the same time thinking of all the things around the house she had to get on with.

When she made the decision to switch to a bottle, she had no problems drying up, so I am unsure whether she had a low supply or whether because demand was low and her mind was elsewhere, nature took care of that for her. The words chicken and eggs spring to mind. I have a crackpot theory. We get most of our milk from cows. How do cows spend their days? They eat, they lie under a tree and contemplate life and their cud. Anyone knows that if you hassle a cow, they lose their milk. Perhaps its the same with humans.

 

 

The child, offered the mother’s breast,

Will not in the beginning grab it;

But soon it clings to it with zest.

And thus at wisdom’s copious breasts

You’ll drink each day with greater zest.

~Johann Wolfgang von Goethe

 

It is babies, too, who need to learn to breastfeed; it is an interactive process. Many babies need to be shown how to use their sucking reflexes. Penelope Leach noted that hospitals can actually sabotage breastfeeding during those crucial early days:“…by giving babies bottles or dummies which she explained as leading to ‘nipple confusion’. It’s a slightly old-fashioned idea now, but basically, Leach suggested that a baby sucks a dummy in a different way to sucking at the breast. Some babies (not all) become confused and cannot suck properly at the breast unless breastfeeding is thoroughly established prior to dummies being offered. Also, alternatives lessen a baby’s need to suck. I must admit I never used dummies with my children simply because I didn’t like them, and the ones I saw seemed to end up on the floor more than in the mouth, but each to their own. Still, it’s worth having the thought at the back of your mind when establishing breastfeeding. After that, I suspect it becomes irrelevant.

Leach stated:

“…unless your baby is ill and under special care, he does not need to be nourished by hospital staff. You can do it. You can produce all the food and fluid your baby needs now he has been born, just as you did beforehand”. It is a belief in women as mothers.

Helen explained how poor professional advice made breastfeeding her daughter much harder than it should have been. Here is a truly appalling tale of professional incompetence and contradictory advice:

Being a first time Mum, I attended NHS parentcraft classes. I suffer from eczema and asthma, so was keen to learn all about breastfeeding. It all seemed so simple – placing your baby on the breast as opposed to washing, sterilising, preparing and warming bottles of formula feed. But there was no discussion of the mechanics of breastfeeding which would have been useful. Although it is important to stress that many mothers find nursing very straightforward, it would also help to learn how to recognise and cope with mastitis, frequent and prolonged feeding and both too much or too little milk, so that mothers would know that with a little help, they should be able to nurse for as long as they wished.

After a precipitate labour, my daughter was delivered with forceps. She was given paracetamol immediately after the birth and put to my breast about forty minutes after delivery. There were three other new Mums on the ward; one had tried to breastfeed but had given up, two had wanted to bottle-feed from the outset. My little girl just slept – for eight to ten hours at a time. I desperately wanted to pick her up, cuddle her and have a go at breastfeeding. Only one nurse actively tried to wake my baby for a feed – at the time, I thought she was being horrible, but now know she was probably doing the best thing. Another nurse suggested a nipple shield, and within twenty four hours, my baby seemed to be nursing better.

At home, midwives visited every day. Each time, they said all was fine despite the fact that my baby was not putting on any weight and was very unsettled. They suggested Infacol (for colic) and a pacifier. On almost every visit, I was asked if I was still using the shield – we were reassured that it was OK. The health visitor also insisted there was no problem in using shields but there was still no weight gain. Several recommendations were made including: nursing every two and a half to three hours during the day but after 11.30 pm leaving the baby to cry herself to sleep in a cot. To nurse for only ten minutes on the left side and twenty minutes on the right, as after this time the baby would be too tired to suck; to drink flat stout with lemonade in the late afternoon to improve the quality of my milk!

After another week, there was still no weight gain. We were very concerned. The health visitor said I would have to supplement with 2-4fl. oz of formula. I voiced my concerns on inducing allergies but was told that as I wasnt lactose intolerant there would be no problem. There was no discussion of how to increase my supply or the problems caused by nipple shields. So, with tears streaming down my face, I gave my precious daughter a bottle of formula milk. I continued giving top up bottles for three days and was told that a 1oz weight gain was due to top up feeds and that we had turned the corner.

I again voiced my concerns and was left with a three hundred and fifty page book to read and put in contact with an experienced breastfeeding mother. I read the book within hours and could not believe the advice Id been given. I called a breastfeeding counsellor to discuss my problem and with her help, immediately stopped topping up and using the shields and set about a completely different feeding regime. I explained to my health visitor what I had learned and what I was doing, that I was feeding almost continually to build up my supply. I confided that I was finding it very tiring. To my horror and confusion, it was recommended that I added in a morning and evening bottle of formula, not as a top up, but as a replacement feed to give me a break, as the quality of my milk would be very poor after 4pm. Also, I should offer a pacifier if my baby was crying. I challenged this as being detrimental to breastfeeding and was told to throw away the books.

After much discussion, my husband called our GP. He said to offer breast milk only for the time being and that he would talk to the health visitor and midwives. The following day, a midwife left a message on my answer phone to increase formula feeds to 5fl oz as my baby was probably still hungry. I am proud to still be breastfeeding at eleven months. although I still continually worry about my supply.

Hardly surprising with such hopeless and incompetent advice.

If only I had been given better advice from the beginning, if only I had followed my instincts, had earlier contact with a lactation professional, fed more frequently in hospital and not used nipple shields, fed on demand day and night, not given a pacifier or supplementary formula feeds, believed in myself and nature – then I would have been able to enjoy breastfeeding rather than be made to feel I was abusing my baby because I wanted to nurse her myself. If we are truly committed to improving breastfeeding success, all available information and support must be freely given at parent craft classes and as often as necessary post-partum.

Jennifer is another breastfeeding Mum :

Im currently breastfeeding my baby daughter, Lauryn, who is five months old and believe that I am doing my very best for her. I just wish that everyone else thought the same. There are still a lot of very old fashioned people in the north-east of England who believe I should not be breastfeeding in public. Recently, I was in a popular restaurant in Newcastle and I started to breastfeed Lauryn. Although I had my cardigan draped over my shoulder, nearly every member of staff walked by to see if they could see what I was doing.

I am trying to wean my daughter from the breast to the bottle, not because I want to, but because I have to. My milk is starting to dry up and I am very disappointed because I wanted to feed her myself for as long as possible. The problem is Lauryn prefers me to a bottle, so I am having a hard time. Although I know it is easier to bottle-feed in public, I prefer to breastfeed her, but I do not have that choice any longer.

Fiona added:

When I was bottle-feeding, the only thing that really bothered me after the initial feelings of failure and guilt (apart from the hassle of the bottles) was the content of breastfeeding information or just plain down the middle articles on breast or bottle, its your choice. I used to get very upset by the idea that people would think that I had actually chosen to bottle-feed. I know some women do choose, but I hadnt.

People like me never got a mention. There were women who breastfeed and then those who, for whatever reason, chose to bottle-feed. You can only say that I chose if you take into account things like a severely dehydrated baby , not even peeing and ketotic, massacred nipples, pain worse than labour. I certainly didnt sit down and think – which shall I choose?

My own impression of people who dont have a happy breastfeeding experience and resort, through need, not choice, to bottles, dont merit a mention is that wemuddy the waters. The pro breastfeeding people want to encourage, inspire, and give confidence about breastfeeding. On the other hand, the entire bottle-feeding information seems to begin with the words if you have chosen to bottle-feed. Now I know they cant say things like if breastfeeding hasnt worked” or similar because it undermines the breastfeeding message and would be seen to be damaging the confidence of new Mums. So, where does this leave the tried but failed’ breastfeeders – in no womans land? I had no help with breastfeeding my first – no one even showed me how to hold a baby to breast feed – I was holding her like a bottle-fed baby, all I had ever seen.

Fiona’s poignant account highlights two important issues – firstly, that bottle-feeding has become the norm. Breastfeeding simply isn’t seen by many people these days. Secondly, if we hold a baby to the breast as we would hold a bottle-feeding baby, then the problems many women and babies have in achieving the correct positioning and latching on begin to make a lot of sense.

What is awful about Fiona’s account is that she desperately wanted to breastfeed but was never shown how to do it, and yes, she does fall into a kind of no-woman’s land of someone who wanted to breastfeed and struggled due to lack of real support. Yes, some people slip through the middle of the breast-bottle dichotomy with scarcely a second thought. I’d reiterate here what I’ve previously said: if you wanted to breastfeed and it didn’t work the problem is a lack appropriate support, societal and structural.

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Susanna’s story shows how each mother and baby breastfeeding experience is different, and how there is a partnership, which like most relationships, doesn’t always go according to plan. Susanna has two daughters aged eight years and nineteen months.

When I was pregnant first time round, I was very apprehensive about breastfeeding, as I could not envisage how something that was part of my intimate sexuality could equate with feeding a baby. The birth was difficult and Ellen was at least twelve hours old when she was brought for her first feed. My attitude wasOK, Ill try for her sake. To my amazement, feeding came easily and we both got it right very quickly.  I was pleasantly surprised to find that it could be a joyful experience, offering closeness like no other. The practical aspects also proved easy; from a few weeks old, Ellen would take expressed milk from a bottle whenever necessary, so I was able to leave her with other family members occasionally, and everything worked out well. I had every intention of feeding Ellen until she was twelve months but she stopped at eight months – I felt that my baby had rejected me.

Lucy was born when Ellen was six and this time, I had no qualms about breastfeeding. I fed Lucy as soon as she was born, and again, we both got it right first time. I bought a new breast pump and planned to feed her for no more than five months, intending that she should be bottle-feeding by the time the next school year started, which would ease the chaos in the mornings. But Lucy had other ideas.

She would not take fluid of any description from any kind of bottle, so I carried on breastfeeding and put up with the limitations on my movements – she and I were, of necessity, inseparable. Eventually, she took to a training beaker, and widened her repertoire to include water, juice and in due course, formula, then cows milk, but she still wanted to breastfeed as well. Now, at nineteen months, she still wont settle at night without a breastfeed, and wakes at least once most nights demanding a feed. When shes tired and whiny during the day, it is the only thing that will restore her spirits, even if shes just had a good meal and a drink of cows milk. I dont quite know what to do. Of course, she wont breast feed forever, and its lovely to have that bond for so long, but Im always exhausted, rarely go out, and have to use nipple cream for the first time ever because shes got a full set of teeth and its often extremely painful.

Which just goes to demonstrate that all babies are different.

 

 

Family patterns

Maire is a good example of someone strongly and positively affected by her family tradition of breastfeeding infants:

I never had any doubts that I would breastfeed, as I am the eldest of seven and my mother had breastfed us all including twins, whom she managed to breastfeed exclusively for three months. It just seemed the right and natural thing to do and Ive never really understood why anyone would actually choose to be lumbered with bottles, sterilising equipment and all the paraphernalia if they didnt really have to. It wasnt until I was expecting my first baby that I realised that some women had problems with breastfeeding so, when asked about my feeding intentions, I began to say Id be breastfeeding“ if I could.

I aimed at feeding my first child, Dominic, for about nine months because thats how long my mum fed me – I had an idea that this was the norm for human babies. I had arranged to return to work (reluctantly) when he was seven months old and I started to express in preparation. I also tried to persuade Dominic to drink from a bottle or cup, but he just wasnt having it. After I returned to work, I expressed milk and brought it home in a cool flask. I knew the EU had issued directives giving breastfeeding mothers rights and knowing this gave me the confidence to ask for time and facilities I required without feeling guilty. I kept it up for nearly three months but Dom got an infection and I felt too washed out to continue. I was working eight hours a day, commuting for four hours plus and feeding Dominic first thing in the morning and last thing at night, but what wore me out was the childcare in the evenings and the housework at the weekends. When Dom was fifteen and a half months, I gave it all up. My Mum and sister were hassling me as they thought it was taking a lot out of me; my husband was supportive, but another infection for Dom finished it. Im not sure if its funny or sad that he threw up his last feeds.

With my daughter, Catherine, I was able to give up work completely and at two and a half she still has a bedtime feed which she and I both look forward to. It wasnt without problems because I had a retained placenta and was in hospital twice with haemorrhaging when she was three and four weeks old. Despite the drip tubes, with help from the nurses, I still managed to breastfeed her which made me feel I wasnt so bad.

Someone told me that breastfeeding takes it out of you, but I didnt find this to be true. It is the lack of uninterrupted sleep which is a debilitating problem. I feel that breastfeeding is a wonderful, natural, cosy thing to do and I have to wonder at the psychology of women who wont use their breasts to suckle their babies.

Sharon explains the very tentative way in which many women approach breastfeeding, but also describes well the dilemma between following professional and family advice:

When I was pregnant, I decided that I would breastfeed if I could but if it caused lots of problems for both of us, then I would just introduce the bottle. I was determined not to get into a state about it but to just give it a go and if it all went well, it would give my baby the best start. I had the full support of my husband. When Rachel was finally born, she started to smack her lips together. I called the midwife to tell her that she wanted to suck. She was very alert, the midwife was great and Rachel took to the breast straight away. The majority of midwives were very helpful but one was not so. I had only been giving Rachel a few feeds and I wasnt sure if I was doing it correctly, so I asked. The midwife in question asked if Id been to classes. When I replied yes, she said then you just do it like that. The poor midwives were run off their feet and had very little time to spend with the mothers. Most were really great and obviously had an enormous workload.

My community midwife spent time helping me to get Rachel on the breast properly and showed me some other feeding positions.  I preferred her lying on pillows tucked under my arm. Once established, I could chop and change positions quite quickly. My family had been very supportive to begin with but later, I became angry when my own mother kept commenting: what a strange way to feed her – youll hurt your back doing it like that. What the hell did it matter which position Rachel liked best as long as she was getting fed adequately? My mother in law, although supportive, kept telling me that she fed her baby every four hours and only for ten minutes on one side and then on the other. We explained numerous times about how it was recommended that you feed on demand and you keep to the same breast because of the two different kinds of milk. In the end, I said nothing. As Rachel grew, my mother-in-law and sister-in-law said they didnt feel very close to Rachel because she was breastfed. I just couldnt accept this and felt quite hurt by it. I was breastfeeding for Rachels sake, not mine – I do think it helps tremendously with bonding and the way she looked up at me when feeding is something I shall never forget as long as I live.

One thing that no one explains to you is how hard it is to get the baby off the breast. By eleven months, she was still feeding whenever she wanted to – I am now gradually reducing feeds. I get really fed up with friends and family commenting … not still feeding her, are you?” which I feel is nobodys business but my own. I dont comment to other mothers about their bottle-feeding or with one friend who went straight from formula milk and onto cows milk when her child was nine months old. The professionals were great, but other people mainly interfered.

There seem to be two main reasons for stopping breastfeeding :

  1. Concerns about insufficient milk or hungry babies come top of the list. Yet almost all mothers have sufficient milk to feed a singleton baby, with many feeding twins, triplets or more without difficulty. Even in starvation conditions in parts of the developing world, women are able to sustain their babies. Insufficient milk is thus rarely a biological problem – it is a question of mothers not having the confidence that they can sustain their babies postnatally as they did beforehand. The idea of the never satisfied, hungry baby links strongly to the almost continual early feeding by breastfed babies – often mothers are providing all the nourishment and comfort their babies need, yet no one warns them that is it normal and natural for a baby to feed incessantly. Their stomachs are the size of walnuts and breast milk suits them perfectly, so is readily digested. Little and often is thus the order of the day. The problem is readily resolved with information and support.
  2. The other reasons offered for stopping breastfeeding include engorgement, painful breasts and latch/sucking problems. These, of course, are all related. A baby who doesn’t latch on correctly will be hungry, she will damage the mother’s breast and the result will be a fractious baby and an unhappy mother who is in pain. The hospital environment does not help babies to suck when artificial teats and dummies are supplied. The answer is not a bottle of formula, although it is rather too readily available as a substitute. The solution lies in addressing the real source of the problem among mothers who express intention to breastfeed.
  3. Then there is the pressure from significant others, both family members, friends and society at large. The logistics of returning to work can also have an impact.

 

In the past, lecturer Fiona Dykes has questioned perceptions of poor milk supply, focusing perceived breast milk inadequacy in lactating women based on her own longitudinal study which explored the lived experience of breastfeeding in ten women. She found that the women had a perceived failure to manufacture breast milk. Those who wished to breastfeed decided to ‘try it’, not confident of any successful outcome. The quality and quantity of their milk were judged via the regular weighing of their babies. This offers a conceptualisation of the female body as a machine prone to failure, as utilised in the infant formula slogan “when breast milk is not enough”, which presents mothers as producers and babies as consumers. Breastfeeding counsellor, Magda, has radically classified the regulation of breast milk as the ‘tyranny of weighing’.

The women in Dykes’study depended very much on a visualisation of measurement which de-legitimizes women’s way of knowing whether their baby is thriving. Weighing is seen as the symbolic extension of medical surveillance with growth seen as a symbol of maternal success and inadequate growth seen as a failure of the mother. Most of the women also illustrated little knowledge of milk production – understandably. They felt that what they ate directly correlated with milk production, a position often reinforced by health professionals. The Royal College of Midwives suggests that mothers eat and drink according to thirst. Some dietary advice from health visitors is more prescriptive and may lead to a cessation of breastfeeding, e.g., linking certain foods in a mother’s diet to infant colic.

Breastfeeding is viewed as a challenging journey, with many falling by the wayside. Inexperienced mothers, along with sometimes incorrect advice from health professionals, can create a misinterpretation of a baby’s behaviour and feeding patterns. But where do community practitioners draw the line? Some women felt they needed more overseeing of breastfeeding but others found this intrusive.

However, more guidance seems to be needed as mothers were often following detrimental feeding practices, such as taking the baby off the breast too soon, restricting the frequency of feeds, dummy usage and poor attachment. Bottles undermine breastfeeding and maternal confidence in our own nurturing skills. Health professionals offering incorrect advice also undermine. Those mothers who succeeded with breastfeeding (against the odds) largely ignored the counter-intuitive advice. What mothers need is support and a holistic approach to this, for family matters also make a great impact.

Many new mothers are thrown back into a traditional female role when they’ve had a baby, after being in reasonably egalitarian relationships – this in itself can lead to enormous tensions. Often, the male partner expects them to readily adapt to the housewife role. Some women find breastfeeding a form of ‘giving out’ and a positive experience; others find it draining and need replenishment, for it is often just one more demand. Support from a significant other person is important – often the partner, sometimes another family member. When breastfeeding is a priority for both partners, this aids success, but partner support remains variable. Some men (and women in lesbian relationships) clearly wish to bottle-feed the baby, and here, the ‘new man’ idea promoted by formula companies has done mothers a disservice. If men are to be fully involved as parents, they do not need to remove the mother’s ability and desire to feed and nurture. They need to know that they can offer their babies other vital care such as skin to skin contact, massage, talking, bathing and nappy changing to encourage closeness. The presence of someone who cares for the mother facilitates breastfeeding success. We, therefore, need to look closely at more resources for postnatal care, currently the Cinderella of the maternity services.

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There must be reasons why we men are so hipped on breasts as if we’d all been weaned too soon. ~Gunter Grass

 

The advantages of breast milk are outlined in virtually every baby book on the shelves. Our concern should not stop with the UK.  Gabrielle Palmer has covered this subject brilliantly already, but it is impossible to write a book about breastfeeding without mentioning developing countries, for what the west does today has a knock on effect in such countries. Basically, in poor conditions, breastfeeding is a literal lifesaver. Bottle-fed babies are fourteen times more likely to die of diarrhoea and three times more likely to die of respiratory diseases than a breastfed baby. Diarrhoea causes dehydration and can damage the gut which makes it impossible to absorb vital nutrients, leading to a cycle of malnutrition.

Yet breastfeeding is declining in developing countries. The main reason for this is the global industry of baby milk and foods which undermine breastfeeding in developing countries, just as it does in developed nations. Even in seriously poor conditions, it is a fact that mothers can satisfactorily breastfeed their babies; starvation is the level at which problems arise. Under-nutrition and intense physical labour do not prevent milk production. Lactation can arise in marginal conditions. Around one-third of the world today has no safe water supply, with many women walking miles to simply fetch water for basic daily needs. With our baths, washing machines, dishwashers and swimming pools, we do not realise what a valuable commodity water is. In the UK, of course, many deaths were caused by poor sanitation before pure water supplies were established. Babies died of the same diarrhoea that babies in the developing world suffer today. But water isn’t the only problem. Baby Milk Action has reported on infants dying in China due to being fed with ‘fake’ baby milk. Closer to home, the World Health Organisation investigated a bacterial contamination of infant formula when a five-day-old child died of meningitis associated with Enterobacter sakazakii contamination of formula, in Belgium in 2002.

Something interesting which arises is that mothers in developing countries work (often extremely hard) and breastfeed. Here, it is seen that to work and to breastfeed is incompatible. Breastfeeding can be quicker than bottle-feeding and can, if necessary, be done while undergoing other activity -once you’re experienced, you need only one hand, as mothers who use the telephone or keyboard regularly as they breastfeed can testify. The nature of work is of course different. In Mali, it is taken for granted that babies accompany their mothers and in other countries, like Ethiopia, groups of women have set up creches. Our work is often more cerebral today, but it can be done with a baby nearby. It is attitudes which need to change.

It seems incomprehensible that mothers use formula milk in countries where to buy such milk takes up a vast amount of family income. It is understandable then that mothers sometimes over-dilute feeds, as mothers living in poverty in the UK do. They are encouraged to buy formula by the continual promotion of it, the undermining of breastfeeding by the very health professionals who should be protecting it, but who are themselves prey to the baby milk company funding and information, and by donated milk supplies during a time of crisis.

Despite the baby food industry’s belief that they act in accordance with the World Health Organisation Code, some have continually attacked it in their pursuit of profit. While ecologically, breast milk is the soundest form of infant feeding, women’s decisions are no longer based on clear, impartial information, but on marketing speak. The function of advertising is to influence. Baby milk manufacturers would suggest that in advertising, all they are doing is encouraging mothers to choose their brand above another, but this is simply not the case. Back in 1939, Dr Cicely Williams, an insightful paediatrician, called the promotion of breast milk substitutes in developing countries“massacre of the innocents” and “misguided propaganda”. Not much has changed. There are overt and covert reasons why women choose specific formulas. Baby milk which has been on the market for a number of years are regarded more favourably, midwives are influential (more so than health visitors) though sisters are also key, subliminal advertising is highly significant, and the confusion of brand name with impartial information for mothers seems to be a deliberate ploy.

For those who choose to bottle-feed, it appears that some intentional bottle-feeders find the idea of breastfeeding embarrassing and others find the idea of others feeding the baby attractive; in very few cases, it’s a ‘can’t be bothered’approach. The formula companies also promote to health professionals which can lead to endorsement by association, mothers believing it must be good if it is supplied by the hospital.

Maria told her story:

I was very determined to breastfeed – at least for a while. Until my sister in law had a baby three years before me, Id never known anyone who breastfed. She started bottles at about four months and I guess I thought Id be the same. I wanted to breastfeed because I thought it would be good for the baby, I couldnt be bothered with all the sterilising, etc., and because my mother didnt breastfeed. The NCT gave me information about combining breastfeeding with bottle-feeding and how you could still breastfeed when you went back to work. This was the first time Id heard that you should breastfeed your baby for twelve months, if possible. There was very little published information about this certainly in terms of practical tips and information. I knew a couple of women in my ante natal class who werent even going to start breastfeeding as they were going back to work quickly. NHS classes did not cover combining breast and bottle-feeding. Midwife support when I was in hospital for forty eight hours was hopeless. I never saw the same midwife twice and got a lot of conflicting information. After my milk came in, I was terribly sore and the community midwife said this was to do with incorrect positioning. She was only with me for ten minutes a day so I ended up one night sitting with my NCT leaflets and feeling by the next morning that Id turned the corner. Had this not have worked, Id have called the breastfeeding counsellor.

I suppose this is where determination comes in. This could have been a low point when someone else might have given up. I also felt very pleased that I had managed my labour without any pain relief and kept saying to myselfif I can do that, I can feed through the pain of cracked nipples.

I was under a bit of pressure from my mother to supplement the baby with bottles (especially during growth spurts) and to feed according to a timetable. I often thought it would be useful to have agranny guide. Things have changed a lot since their day. Having to argue about this in the early days of having a baby is a waste of energy. 

Again, had I not been such a contrary person, I may have taken my mothers advice and started cutting down on breastfeeding at around six weeks. I fed my baby for twelve months, when she gave up on her own. I tried her with a bottle of expressed milk a couple of times, but she would not take it, so I gave up. I think I tried her with bottles because I had bought some bottles and had been given a steriliser. When my second baby was born ten months later, I didnt expect to experience problems with feeding. He was terribly hungry and sucked like mad before the milk got in. I got terribly engorged and sore again. I was surprised and a little upset by this as this time I knew that my positioning was correct. It took about five days to be back to normal. He was much hungrier than my little girl had been, but there was always lots of milk and I didnt suffer so much from growth spurts as previously. I fed my son for fourteen months though I think he would have continued for longer. I didnt bother trying him with a bottle at all.

Although health visitors were always supportive, they made it clear through their language that I was unusual for feeding my babies for so long. When I had thrush of the nipple when my second baby was twelve months old, the GP made some very negative comments about me still breastfeeding at that stage. He was also unable to diagnose the thrush. I got advice from a counsellor who helped sort out the problem. Had I not been an experienced breastfeeder, I may not have understood that the GP did not know what he was talking about and this may have been another point where I could have given up. Information about breastfeeding is very vague, especially in magazines which are probably the main source of information for most mothers to be. There is very much an attitude offormula is fine, tooso that mothers dont feel alienated. If health professionals were to saywe really recommend that you breastfeed your baby for at least four months and up to a year if you canthen that would be a clear and consistent message. The message I picked up is we like you to try’.

New mother, Sarah, said:

Basically I have gone from being a whole-hearted advocate of the breast is best’ position to a much more open-minded point of view, and I really would like to see less polarisation between the two methods, with more information and support given to women who choose either way of feeding or a combination of both.

It took me three and a half years to conceive my baby. In that time I miscarried one naturally-conceived pregnancy and had two failed attempts at assisted conception. In April 2003 my second attempt at IVF was successful. From five and a half weeks I suffered extreme pregnancy sickness and was twice hospitalised and fed on a drip. I lost a stone, becoming very dehydrated, unable to eat or drink anything without vomiting. Eventually drug treatment enabled me to start eating again and I was able to return to work. When I gave birth in December I went through a nine hour labour before undergoing an emergency Caesarean. The immobility following the operation was difficult interfering with my ability simply to pick up and tend to my baby, which made the first days quite stressful. It was in this context that I began to breastfeed.

I made the decision to breastfeed because close friends had done it, I suppose I regarded it as thedone thing, morenatural’‚and I felt duty-bound to do it because it appeared that it would be best for my babys health, although I had doubts about wanting to breastfeed in public, and about being the only one who would be able to feed the baby. But I was committed to the idea of it, and in fact secretly quite judgmental about those who did not even try it or give it a fair go.

My actual experience of breastfeeding has converted me to a much more informed, open-minded attitude about the whole subject. It has taught me what I should have known already – that you cant make judgments until you have stood in someone elses shoes. In the event, although my decision to turn to bottles caused me heartache and conflict and sadness at the time, it was a huge relief when I did it, it enabled me to start to fully bond with my daughter, and I am very grateful that there are good alternatives to breast milk available  when I was trying to continue breastfeeding despite my difficulties.

I fed my daughter for three weeks. I must have fed her over two hundred times in those weeks; my problems began with cracked and bleeding nipples, which I treated with a salve which at least got me to the next feed. Despite regular, sometimes almost constant, feeding my breasts were monstrously enlarged, painful and sore and cumbersome. I could not feed discreetly with them and never fed in public.  The pain at latching-on was excruciating and did not always subside during the feed, so that I was sometimes sobbing over my baby as she fed. Eventually, I developed a blocked duct and feared I was well on the way to mastitis, especially when one breast developed an inflamed patch and I suffered night sweats.

During this time I read everything I could lay my hands on, but everything I read said that all problems stemmed from bad technique. I had had a great deal of advice and support about this both in the hospital and from my health visitors in the home, and had been assured again and again that my baby was latching on perfectly. Eventually we went to the local breastfeeding drop-in clinic and were told that my daughter had a narrow palate which was making it uncomfortable for me and that I would need to latch her on slightly differently. This worked wonderfully in the clinic but I only managed to achieve it once when alone at home things were different. 

I was also finding it impossible to get into a comfortable position when feeding, despite the aid of many pillows and cushions, and would end up with a painfully aching back and arms. This no doubt would have improved with time; as would the narrow palate as the baby grew, and in time my breasts would have settled down and been more comfortable. But paralysed in my chair one night when I had been feeding for hours and hadnt been able to get up to turn the electric light on, sobbing in the darkness over my painful breasts and my failure to enjoy my baby as I wanted to, I knew it had become inevitable I would give up feeding.

At that point both my husband and I still hoped that I could combine breast and bottle. I tried to express milk, but this too was very painful and produced absolutely nothing. I never had the problem of leaking breasts – even when I stopped feeding suddenly they only leaked a little bit and for a short time. In the end and with huge reluctance I gave up the plan I had had of feeding my daughter exclusively on breast milk until six months. It was a painful and difficult decision, and I felt very sad that she was moving from her own personalised milk to one produced for any baby. I had waited a long time for a child and was aware that this might be the only milk I would ever produce in my lifetime, but in reality it was with huge relief and liberation that I saw it dry up and my breasts return to normal size and consistency.

At last I could embrace motherhood with energy and enthusiasm. Formula was a blessing to me – it was wonderful to know my baby would still thrive but that I could remain sane and happy! And bottle-fed babies do thrive – after all its what they eat once theyre weaned that will probably make the difference to their future health and well-being.  I challenge anyone to tell a breastfed baby from a bottle-fed one on any criteria. If there are differences, they are too small to show up between individuals. It so happens that the babies I know with eczema are breastfed ones. The differences are simply not marked enough to justify the self-righteous prejudices of a minority of breastfeeding advocates. The WHO guidelines may be absolutely the right thing for parts of the world where childrens health is much more seriously under threat, but it ignores the complexities of social, emotional and practical considerations which are relevant to women in industrialised countries.I am distrustful of any argument that bases itself just on what is supposedlynatural. Nature is not by any means always beneficent or reasonable; in fact it can be merciless and unjust. Left to nature I would perhaps never have conceived a baby, or if I had I would have died of pregnancy sickness or in labour, so thank God for IVF, for intravenous rehydration, for anaesthetics and pain relief. And thank goodness for the option of feeding my baby not as nature intended.

 

I gathered some of the material in this book a while ago, and have since updated and revamped it. At times, I’ve wondered if it was worth doing, but one day, as I checked my Facebook page, I noticed an article which said that there had been a relaunch of a breastfeeding support group in Bodmin by a woman called Emma Frost. Emma was sixteen when she set up Bosom Buddies in the town. Eleven years on, she is still as passionate about breastfeeding as ever and wants to help other mothers. She said:

Breastfeeding may not be for everyone and that’s fine, but there is nothing more heartbreaking than a women who wants to naturally feed her baby but can’t due to lack of knowledge and support. The local midwifes and health visitors just don’t have the time to sit with a woman for hours and tell her she’s doing a good job and support her in the way we can, and if that was lost it would be terrible.

Women and families need this support in the most amazing but daunting time of their lives…

 

So, my thanks to Emma Frost who has inspired the final push for me to complete this book and finally publish it on my blog. I hope it helps some mothers to enjoy breastfeeding and to revel in their own bodies.

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Here’s a couple of quotes to end on:

 

[Bottle feeding] also made a fetish out of cleanliness, and maybe all the washing and scrubbing has further reduced the pleasure we take in our body and in life. ~Author Unknown

 

Breastfeeding is an unsentimental metaphor for how love works, in a way. You don’t decide how much and how deeply to love — you respond to the beloved, and give with joy exactly as much as they want. ~Marni Jackson

 

 

 

 

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