Breastfeeding is perhaps the most misunderstood aspect of motherhood in our society today. I am continually amazed at the persistent lack of basic breastfeeding knowledge, the depth and strength of "Old Wive's Tales" and the abundance of misinformation.
"Cultural, social and medical interventions during the past 3000 years have so modified child care practices that we now find it difficult to see what 'nature . . . intended' (Gartner 502)." We have lost the ability to breastfeed our children "naturally" in our, modern world. Traditional belief in the miracles of our innate physiology is lost in western societies. Often, we become too scientific, believing that somehow the original design was flawed or that evolution has rendered the female breast a mere object of aesthetics. Suzanne Arms states "We have paid dearly for every 'advancement' because each step has altered our world view." By becoming so technical "we have lost a respect and reverence for nature and all natural processes . . . (216)"
Breastfeeding and nurturing are learned skills. In the few remaining traditional societies women do "just breastfeed" with very few problems. In such societies, breastfeeding is done openly. The converse is true in our culture. There are few open breastfeeding role models for young women to study. Most adult women have never watched another woman nurse. Expectant and new mothers may turn to an acquaintance who nursed a baby, often for a very short period, for advice. Unfortunately such advice comes tainted with tales of difficulties. Uneducated or frightened expectant mothers may feel compelled to bottle feed from the pictures of pitiful failure, pain and other breastfeeding complications painted for them by women who should know better: women who have breastfed.
New mothers are leaving the hospital in as little as 48 hours after the birth. They are left to discover breastfeeding and mothering on their own. Home support is generally unavailable because their mothers and grandmothers did not breastfeed. Half the mothers who initiate breastfeeding, will prematurely wean within a few days or weeks due to preventable or treatable difficulties. Izatt found that 72% of the women she studied had questions in the first two weeks. She also found women relied on books, and not health care professionals, as their most common source for breastfeeding information postpartum (111). More preventable difficulties occur within the first week postpartum than at any other time during lactation. Yet, the average mother- infant pair are not seen by a health care professional for two to six weeks after discharge.
Research is repeatedly proving that breastfeeding is more than the act of transferring milk. Breastfeeding is nurturing. Even before mother-infant attachment research, the major reason to breastfeed was to provide a special bond between mother and child. "This [special bond] was evidenced by it being considered more appropriate to present breastfeeding as a matter of personal choice." Oddly, the major contraindication to breastfeeding remains the lack of desire to do so. (Lawrence and Lawrence 197-198)
Mother - infant attachment begins early in pregnancy. Expectant parents proudly display ultrasound pictures that are placed in baby books as baby's "first" picture. Feeling the baby's first movements makes the pregnancy more real for the mother. Meanwhile, baby is hearing the sounds of his mother through the uterine wall. He tastes the spices and foods mom eats as he drinks the amniotic fluid. He learns his mother's smell from the smell of the amniotic fluid. The baby's preference for the smell of amniotic fluid changes to a preference for the smell of his mother's milk in four or five days. ( Mailer, Schaal and Soussignan; Varnsi, Porter and Weinburg)
Following birth, immediate contact continues the bonding process. (See: Changing Hospital Routines to Support Lactation) An alert, active newborn will search for his mother's breast. Infants from unmedicated labors, methodically "crawl," without assistance, up to the breast and self-attach when they are left undisturbed on the mother's abdomen in the moments following birth (Righard and Alade 1990). As baby adjusts to the outside world, he begins to learn his mother's face, her smell, the taste of her milk, and her touch. Mothers have an intense need for eye-to-eye contact with their baby after birth. After an unmedicated labor the baby is in the perfect quiet alert state for a prolonged period of eye-to-eye contact.
(Kennell and Klaus 7-8) Mother makes eye contact with the infant, en face, and begins gentle stroking of the baby. Hidden cameras reveal that if the couplet is left undisturbed, in total privacy, many mothers will kiss and taste their infants (Klaus 1998). The initial breastfeeding contact has multiple physical and psychological effects on mother and baby. These actions incorporate her image of the unborn baby with the real infant she now holds. Postpartum bonding has begun. The maternal-infant bond is the strongest human bond. The baby grew within the mother and his survival after birth depends on her care (Lawrence and Lawrence 198) "Sensitive periods in biologic phenomena are times when events can alter later behaviors (Lawrence and Lawrence 201)." There are hormonal components to human bonding. Maternal estrogen, progesterone, and prolactin are believed to be responsible for many mothering behaviors.
For the human female, the first few hours after delivery is the sensitive period for bonding. In Thailand where a disturbing number of women abandoned their babies, the initiation of Baby Friendly with its early infant contact and rooming in policies reduced the number of abandoned infants from 33 per 10,000 to 1 per 10,000. Reports are similar in several other countries. Clearly early, frequent contact between the mother and infant in the hours and days following birth have a special significance in human bonding. (Kennell and Klaus 7-11)
If immediate contact is delayed, for reasons such a general anesthesia, prematurity, or illness, the bonding process in most of these situations will undoubtedly begin with the mother's first infant contact. However, the longer the initial contact with the infant is delayed, the more difficult bonding becomes.
Inability to Breastfeed is Critical Emotionally for the Mother
Speak to any successful nursing mother about her experience and it readily becomes apparent that breastfeeding is an emotional issue. Her memories are not physical ones but rather they are memories of feelings.
Breastfeeding itself is emotionally significant for the mother who wishes to nurse. A breastfeeding woman may measure her mothering capabilities by her ability to provide milk at the breast. Her own self concept is intertwined in the nursing relationship. It is this emotional investment that causes breastfeeding women to become hostile and depressed when they are told they cannot nurse. The woman who is told she must wean, even temporarily, feels a sense of loss as real as if someone has died (Lawrence and Lawrence 212). Mothers have been known to delay needed medical treatment for themselves for the sake of preserving the nursing relationship.
Mothers who have disappointing experiences with initial breastfeedings use strong negative adjectives when describing their infants' behavior at the breast: "He rejected my breast." "He doesn't like me, he likes the bottle better." These comments suggest that she believes the infant has not bonded to her or that she is a bad mother.
When a sick or premature infant is separated from his mother in a Neonatal Intensive Care Unit (NICU), her mothering duties are assumed by other care givers. The technical aspects of the NICU, often disconnect the mother from her infant's care. Early discharge practices further separate the mother from her infant. The mother may feel that she is a stranger to her own baby. Many women rightly believe that the only thing they alone can do to enhance bonding is to breastfeed. She may diligently pump her breasts for weeks (or months) to maintain a milk supply. Then when mother's first attempt at breastfeeding her sick baby occurs, she is usually left on her own to discover how to nurse a previously bottle fed infant. Without the proper assistance at these early feedings, she is doomed to breastfeeding failure. (See: The Premature Infant)
Breastfeeding provides continued close contact between mother and child. Social interaction is frequent and prolonged. The breastfed infant is in control of the feeding. Breastfed infants show more body activity at one to two weeks of age, are more alert and have stronger arousal reactions. Mother's breast is the source of warmth and comfort. The baby associates his mother with nourishment and interacts with her rather than with a bottle. The infant who is bottle fed will eventually be left to feed himself, rather than having all his feedings in mother's arms. Breastfed infants start walking an average of two months earlier than their bottle fed counterparts. It is believed that breastfed infants are more secure and will later become more independent than bottle fed infants because they are held so often throughout infancy. The longer an infant is breastfed, the more striking developmental differences become. (Lawrence and Lawrence 209
[to part 2: The History of Infant Feeding]
Copyright Marie Davis, RN, IBCLC 1999
[The Legacy of Scientific Motherhood]