Petition to ban advertising of artificial baby milks

January 16, 2012

Well, it’s been a while since I wrote anything on here, ahem. I hope to be back in action soon. In the meantime, if anyone out there is reading, please have a look at this petition. (Usual caveats about not being anti-formula and so and and so forth – this is about advertising, illegal marketing practices, and informed parenting choices.)

 

http://epetitions.direct.gov.uk/petitions/24494

Facebook hates us!

February 8, 2010

It’s late, I’m tired, and decidely inarticulate, so to cut a long story short, facebook hates breastfeeding and wants to wipe any suggestion of it of the face of the book.

It started with random deletions of FBers breastfeeding photos, proceeded to deleting accounts without warning or explanation, and then to the announcement from FB that images breastfeeding were ‘obscene’. In response, this group was set up to petition FB to change their policy. The group is now under threat, so this group has been set up as a back up. There is also this site, where you can see the images that facebook considers so digsusting they had to remove them.

Below is the official press release from the FB advocacy group. What else we can do, I’m not sure. Sigh.

Oh, and just for good measure, a more detailed report is here on the best darn breastfeeding advocacy blog around.

PRESS RELEASE

5th February 2010

For immediate release

FACEBOOK TO BAN BREASTFEEDING ADVOCACY GROUP FOR “OBSCENITY”

Lactivist group faces termination from Facebook after embarrassing the social networking site in high profile media awareness campaign last year.

The group of almost 250,000 members faces threats of removal after a media blitz that chastised the social networking site for its draconian policies toward breastfeeding mothers. The campaign, which garnered national and international attention in over 25 languages from various media outlets around the world, was featured on CNN, CBS News and the Dr. Phil show among others. Members believe the current threat is directly related to the embarrassment caused to Facebook’s bosses.

Administrators of the group, “Hey Facebook, Breastfeeding is Not Obscene! (Official petition to Facebook)” were told by the social networking site that the group was in violation of copyright infringement policies. When pressed for details by the group’s admin, Facebook responded by changing the accusation to say the group was posting nudity or sexually explicit material and sending harassing messages to members.

Ms. Joseph says she believes the harassment is due to the social networking site being embarrassed that such a large number of people are against their policies of branding breastfeeding photos as “sexually explicit content”. “We have no idea what they’re talking about and they won’t explain the charges,” said Gillian Joseph , an admin of the group, living in Edinburgh, Scotland. “We checked our pages but can’t see any copyright infringements, and we’ve certainly sent no harassing messages. Now they’re saying it’s because we’re uploading obscene photos.”.

The support and advocacy group, which boasts over 247,000 members from all over the world, wishes to normalize the sight of breastfeeding mothers and children. It currently contains over 4,500 discussion threads on parenting topics, and over 5,700 photos – though some of these have already been removed by Facebook.

“To shut the group down would not only end valuable support, but give a message to the world that breastfeeding babies are somehow obscene. It’s just absurd,” said Debra Balcaen, a Winnipeg resident and administrator of the group.

“It is unfortunate and hypocritical that Facebook’s administration has targeted this breastfeeding advocacy group for alleged violations when at the same time they happily endorse sexually explicit material from third party applications and paid advertisements.”

END

NOTES FOR EDITORS:

Initial emails from Facebook were sent on 2/2/10 to the administrators of the group. All responses were handled by Gill Joseph, and the full email exchange can be provided upon request.

During previous campaigns, articles about the group have featured in The Washington Post and Fox News in the U.S., in The Guardian and The Times in the U.K., and in The Globe and Mail and The Ottawa Citizen in Canada.

The group has administrators in Canada, USA, UK and Australia who can be contacted on request, but main contacts for the media are:

Gill Joseph email: kamagrian@blueyonder.co.uk

phone: +44 7800 987 844 +44 7800 987 844

Stephanie Muir email: babieslovemilk@yahoo.ca

phone: +1 613 761 9109 +1 613 761 9109

Please note that email may be a better first contact choice, as both women are mothers of young children.

Out of the mouths of babes…

February 4, 2010

So, this isn’t very radical, but I felt moved to share a little personal story. I want to share it particularly in light of the recent scandal with Clare Byam-Cook, and media coverage over feeding older babies. All too often, people – from C B-C, to woefully ignorant but actually practicing medical professionals, to the average person on the sofa – are quick to say that since there ‘no nutritional benefit’ after 6 minutes/weeks/months/one year (delete as appropriate depending on the speaker), older children do not need to breastfeed, and so continuing to nurse is clearly ‘for the mother’s benefit’. Some imply that this is a sort of psychosis of overprotective mothering, others go so far as to accuse mothers of child abuse for sexual gratification. Rarely do any of these people actually talk to any older nurslings. And so.

Yesterday was a challenging day with my toddler. We had to leave his best friend after a two day visit and travel for many hours on a variety of trains and busses, many of which were late. He was tired, he was sad, and I was trying so very hard to be patient. But by the 5th hour of travel, I’d run out of snacks (two oranges, a banana, and a box of crackers having gone down the hatch), and ideas too. It was well past his bed time, he kept asking to go back to his friend’s house, and to get off the train, etc. I was in that typical frazzled-mother state of just offering one thing after another – do you want a story? a song? a drink of water? – he looked at me, stopped whining and said, “no, I want mok” (his word for breastfeeding). I said, “oh, sure, no problem” (and mentally slapped myself for not having offered sooner, but he hadn’t looked like he was in the mood).

As he clambered happily into my lap, he explained to me, “I’m sad, and it makes me feel better”.

Does nursing my 2 and a half year old son benefit me? Do I find it gratifying? You betcha.
But just you try to tell him that he doesn’t need it, doesn’t want it, and shouldn’t have it. Ha. That would cause a meltdown that only one thing could cure… MOK!

Latest Clare Byam-Cook Scandal

January 29, 2010

Well, obviously everyone else has already addressed this more eloquently and amusingly than I can (see this blog post), but I feel the need to make a brief mention of the latest scandal over Clare Byam-Cook’s ahem, interesting, approach to breastfeeding.

Appearing on GMTV on a discussion about breastfeeding older children, C B-C  said “Breast milk beyond the age of 2 isn’t necessarily good because it’s very, very sweet. The fact that it’s breast milk doesn’t make it any different to a glass of Coca-Cola.” Once again demonstrating her phenomenal lack of knowledge related to both breastfeeding and child nutrition.

Since others have covered this topic so well, I would just like to run through a few quick points.

– Clare Byam-Cook’s credibility rests on her apparent qualifications as a midwife and ‘breastfeeding specialist’. According to the information on here, she ‘retired’ from practising midwifery in 1985 (a few short years after she must have started), and hasn’t practised, or presumably been licensed or done any further professional training, since. Her bio does not list, nor am I aware of, any actual training in breastfeeding support or management. Now, unfortunately, anyone can call themselves a ‘breastfeeding specialist’, and she’s certainly made a great deal of money trading as one and selling books on the subject, but it appears that she has no specialised training whatsoever, and any training she may have received as part of midwifery studies would now be at least 25 years out of date. Back in 1985, recommendations were still for routine separation of mother and baby, routine administration of artificial milk supplements, and scheduled feeding. So I guess that explains why she’s still promoting many such ridiculously outdated ideas. As ever, Clare Byam-Cook remains a shining example of why, when someone gives you proscriptive advice and claims to be an ‘expert’, you should never ever take them at face value!

Further to the specifics of this outrage, I’d like to say a few things about breastfeeding, breastmilk, and tooth decay.

– Sugar does not cause tooth decay, bacteria do. They are attracted to sugar on the teeth, and then wear away the enamel. More on that here
-Breastmilk does not contain the same sort of sugar that Coca-cola does – and lactose is not as attractive a sugar as sucrose/fructose for those sorts of bacteria
-In addition to sugar (lactose), breastmilk also has antibacterial properties that partially mitigate the effect of the sugar if you really want to, read more here
-Breastfeeding delivers the fluid differently than drinking out of a bottle or a cup. Drinking from a bottle or cup allows the liquid to pool behind the teeth, making it a prime ground for attracting bacteria to eat that tooth enamel. However, because of the way a baby latches onto the breast, breastmilk is actually delivered down the throat, bypassing the teeth entirely.
-Breastfeeding, even at night, even after toothbrushing, and even in older children is not associated with any increased risk of dental caries. In fact, ‘bottle-mouth-syndrome’ refers to artificially-fed babies plagued by caries.

For a fascinating, informative, and very graphic look at this issue, check out Brian Palmer, DDS

So, to sum up.
Breastfeeding. Does. Not. Cause. Caries.

Clare Byam-Cook is putting babies and mothers at risk with her insidious misinformation, and should be stopped. While I am titillated to see her stupid quote splashed all over the media, I am worried that this was all a ploy to get tons of press coverage… has she got a new book coming out?

Urgent Appeal for Coca-Cola Donations

January 29, 2010

A brilliant piece of satire by a brilliant blogger. And so creative, too… I mean, Clare Buyme-Book has such an uncanny lack of resemblance to any real person…
Urgent Appeal for Coca-Cola

Bottlefeeding Simulates Child Loss – Medical Hypotheses Article

January 29, 2010

This is the further article to a previous post. I think it’s a really interesting approach to this topic.

Bottle feeding simulates child loss
29.1.2010

Medical Hypotheses

Volume 74, Issue 1, January 2010, Pages 174-176

Bottle feeding simulates child loss: Postpartum depression and evolutionary medicine

Gordon G. Gallup Jr., a, , R. Nathan Pipitonea, Kelly J. Carronea and Kevin L. Leadholma

aDepartment of Psychology, University at Albany, State University of New York, Albany, NY 12222, USA

Received 2 July 2009;  accepted 5 July 2009.  Available online 8 August 2009.

Summary

At the level of a mother’s basic biology, the decision to bottle feed unwittingly mimics conditions associated with the death of an infant. Child loss is a well documented trigger for depression particularly in mothers, and growing evidence shows that bottle feeding is a risk factor for postpartum depression. The implications of this hypothesis for infant feeding practices, hospital procedures that lead to intermittent separation between mothers and infants during the immediate postpartum period, parallels between an increased desire to hold infants by mothers who bottle feed and responses to infant death among nonhuman primates, and the relationship between weaning and depression are discussed in the context of an emerging discipline known as evolutionary medicine.

Article Outline

Evolutionary medicine

Bottle feeding

Lactation

Bottle feeding simulates child loss

Conclusion

Conflict of interest statement

References

Evolutionary medicine

Growing evidence shows that knowledge of human evolutionary history and mismatches between evolved adaptations and different aspects of our contemporary existence can have important medical and epidemiological implications [1]. For instance, population differences in the susceptibility to lung disease appear to be related to early geographical differences in the reliance on fire for warmth and food preparation and resulting selection due to differences in the inhalation of smoke as a byproduct of combustion [2]. There is also growing evidence that impregnation as a consequence of exposure to unfamiliar semen (i.e., infrequent insemination by the father) increases the risk of preeclampsia and other forms of spontaneous abortion [3].

Evolutionary medicine also applies in the psychological domain. Research on paternal resemblance shows that men are far more likely than women to invest preferentially in children with whom they share common facial features [4] and [5]. A clear implication of such findings is that matching phenotypic features of children being considered for adoption with those of their adoptive fathers could be used to improve adoption outcomes.

Bottle feeding

The present paper focuses on the decision people make to unwittingly depart from one of the defining features of mammalian evolution: to bottle feed rather than breastfeed their infants. For 99.9% of human evolutionary history the decision not to breastfeed would have been tantamount to committing infanticide. The technology that lead to bottle feeding as a substitute for the breast (e.g., bottles, rubber nipples, formula) has only become available within the last 100 years. Nowadays, the decision to bottle feed can be made by design (e.g., out of a concern for the effect on the mother’s figure, embarrassment about breastfeeding in public, time constraints due to employment) or by default (e.g., physical inability to breastfeed or where the mother produces inadequate breast milk).

With the advent of bottle feeding technology, there was a decline in breastfeeding in this country and elsewhere during the past century [6], but as significant advantages of breastfeeding for both the infant and the mother have become evident [7] and [8] the pendulum has begun to swing in the opposite direction. The focus of this paper, however, is not on the advantages of breastfeeding per se, but rather on the negative psychological consequences of the decision not to breastfeed.

Lactation

Pregnancy triggers a variety of hormonal changes that prepare the mammary glands to produce milk to meet an infant’s immunological and nutritional needs. Across the course of pregnancy, the breasts change internally and externally in response to prolactin, lactogen, estrogen, progesterone, ACTH, and growth hormone [9], with lactation kept at bay by high levels of circulating progesterone and oestrogen [10]. Lactation is triggered by the rapid drop in progesterone following placental birth, but other changes including the release of prolactin and oxytocin, along with cortisol, thyroid-stimulating hormone, and additional hormones are implicated in this process [9].

Once begun, lactation is largely maintained by prolactin, although oxytocin is responsible for the milk ejection reflex (MER), and is released into the mother’s bloodstream at every feeding [9] and [11]. After lactation is established, however, prolactin does not dictate milk production volume. Suckling alone removes very little breast milk. Instead, the MER triggered by oxytocin release provides the largest proportion of breast milk consumed [11]. The MER initially requires physical stimulation (suckling) but eventually becomes conditioned, and can be activated or inhibited by various cues [10]. Once conditioned, women can experience milk ejection, and the concomitant release of the lactogenic hormones oxytocin and prolactin, from merely thinking about, smelling, or hearing their baby cry [12].

If the MER is inhibited, milk remains undrained in the breast, and autocrine mechanisms work to inhibit milk secretion [10]. With complete cessation of milk removal, secretory capacity is eventually lost, although relactation is possible through breast and nipple stimulation [13].

Since milk production is dependent on removal of milk from the breasts when complimentary foods are introduced into the infant’s diet, milk production is reduced. This starts the process of weaning, whereby infants move from a diet consisting exclusively of breast milk to one where breast milk becomes a supplement and is eventually no longer consumed. The physiological process that occurs when the breast changes from a milk-producing organ back to one that is largely quiescent is known as involution.

Bottle feeding simulates child loss

Opting not to breastfeed precludes and/or brings all of the processes involved in lactation to a halt. For most of human evolution the absence or early cessation of breastfeeding would have been occasioned by the miscarriage, loss, or death of a child. We contend, therefore, that at the level of her basic biology a mother’s decision to bottle feed unknowingly simulates child loss. The death of a child is a well documented trigger for profound parental grief and depression [14], and evidence shows that mothers tend to be more affected than fathers [15]. Suarez and Gallup [16] theorize that depression in response to the death of a child may be an adaptive mechanism that functions to (1) punish instances of inappropriate parenting or neglect, and (2) trigger social and psychological support from close friends and relatives during the particularly difficult period following the loss of an infant (see also [17]). Because bottle feeding simulates child loss at a physiological level it may also play an important role in postpartum depression.

Consistent with this analysis, there is growing evidence that bottle feeding is a significant risk factor for postpartum depression [18], [19], [20] and [21]. Some claim that breastfeeding can reduce the incidence of postpartum depression by as much as 50% [22]. Additional evidence in support of our hypothesis comes from the fact that postpartum depression is not an uncommon response to weaning [23] and [24]. Because weaning results in the cessation of milk production in much the same way that bottle feeding does, weaning/involution can also be thought of as mimicking child loss.

We recently completed a study of over 50 mothers recruited through local pediatric offices at 4–6 weeks postpartum [25]. Consistent with previous reports, we found that those who bottle fed their babies scored significantly higher on the Edinburgh Postnatal Depression Scale than those engaged in breastfeeding. The increased risk of depression among mothers who relied on bottle feeding held true even after we controlled for such things as age, education, income, and the mother’s relationship with her current partner.

As further support for the idea that bottle feeding activates mechanisms associated with child loss, we discovered that mothers who bottle fed their infants reported wanting to hold their babies significantly more. This parallels findings among nonhuman primates where in response to the death of an infant, mothers of some species have been known to tenaciously hold, cling to, and carry their infants for prolonged periods after they die [26] and [27].

As noted by Suarez and Gallup [16], the common hospital practice of isolating newborn infants together in a nursery for the first couple of days after birth, and the resulting intermittent separation of the mother from her baby during the initial postpartum period could also serve to simulate child loss and contribute to or prime subsequent postpartum depression.

Conclusion

Bottle feeding practices and hospital procedures that simulate child loss may increase the risk of postpartum depression and fall within a growing number of medical issues that could benefit from an evolutionary perspective.

Conflict of interest statement

None declared.

References

[1] W.R. Trevathan, Evolutionary medicine, Annu Rev Anthropol 36 (2007), pp. 139–154. View Record in Scopus | Cited By in Scopus (4)

[2] S.M. Platek, G.G. Gallup Jr. and B.D. Fryer, The fireside hypothesis: was there differential selection to tolerate air pollution during human evolution?, Med Hypotheses 58 (2002), pp. 1–5. Abstract | PDF (90 K) | View Record in Scopus | Cited By in Scopus (6)

[3] J.A. Davis and G.G. Gallup Jr., Preeclampsia and other pregnancy complications as an adaptive response to unfamiliar semen. In: P. Shackelford and T. Platek, Editors, Female infidelity and paternal uncertainty: evolutionary perspectives on male anti-cuckoldry tactics, Cambridge University Press, New York (2006), pp. 191–204.

[4] R.L. Burch and G.G. Gallup Jr., Perceptions of paternal resemblance predict family violence, Evol Hum Behav 21 (2000), pp. 429–435. Abstract | Article | PDF (78 K) | View Record in Scopus | Cited By in Scopus (25)

[5] S.M. Platek, R.L. Burch, I.S. Panyavin, B.H. Wasserman and G.G. Gallup Jr., Reactions to children’s faces: resemblance affects males more than females, Evol Hum Behav 23 (2002), pp. 159–166. Abstract | Article | PDF (1006 K) | View Record in Scopus | Cited By in Scopus (36)

[6] J. Knodel, Breast-feeding and population growth, Science 198 (1977), pp. 1111–1115. View Record in Scopus | Cited By in Scopus (8)

[7] M.J. Heinig and K.G. Dewey, Health advantages of breast feeding in infants: a critical review, Nutr Res Rev 9 (1996), pp. 89–110. View Record in Scopus | Cited By in Scopus (79)

[8] E.S. Mezzacappa, R.M. Kelsey and E.S. Katkin, Breast feeding, bottle feeding, and maternal autonomic responses to stress, J Psychosom Res 58 (2005), pp. 351–365. Abstract | Article | PDF (373 K) | View Record in Scopus | Cited By in Scopus (9)

[9] J. Riordan, Breastfeeding and human lactation (3rd ed.), Jones and Bartlett Publishers, Sudbury, MA (2005).

[10] S.A. Spencer, The physiology of lactation, Pediatr Child Health 17 (2007), pp. 244–248.

[11] J.C. Kent, How breastfeeding works, J Midwifery Women Health 56 (2007), pp. 564–570. Abstract | Article | PDF (303 K) | View Record in Scopus | Cited By in Scopus (5)

[12] N.M. Hurst, Recognizing and treating delayed or failed lactogenesis II, J Midwifery Women Health 56 (2007), pp. 588–594. Abstract | Article | PDF (199 K) | View Record in Scopus | Cited By in Scopus (4)

[13] R.E. Brown, Relactation: an overview, Pediatrics 60 (1) (1977), pp. 116–120. View Record in Scopus | Cited By in Scopus (6)

[14] J. Bowlby, The making and breaking of affectional bonds, Tavistock Publications, London (1979).

[15] J.C. Vance, J.M. Najman, M.J. Thearle, G. Embelton, W.J. Foster and F.M. Boyle, Psychological changes in parents eight months after the loss of an infant from stillbirth, neonatal death, or sudden infant death syndrome – a longitudinal study, Pediatrics 96 (1995), pp. 933–938. View Record in Scopus | Cited By in Scopus (34)

[16] S.D. Suarez and G.G. Gallup Jr., Depression as a response to reproductive failure, J Soc Biol Struct 8 (1985), pp. 279–287. Abstract | Article | PDF (703 K) | View Record in Scopus | Cited By in Scopus (5)

[17] E.H. Hagen, The functions of postpartum depression, Evol Hum Behav 20 (1999), pp. 325–359. Abstract | Article | PDF (170 K) | View Record in Scopus | Cited By in Scopus (40)

[18] C. Dennis and K. McQueen, The relationship between infant-feeding outcomes and postpartum depression: a quantitative systematic review, Pediatrics 123 (2009), pp. 736–751.

[19] P. Hannah, D. Adams, A. Lee, V. Glover and M. Sandler, Links between early post-partum mood and post-natal depression, Brit J Psychiat 160 (1992), pp. 777–780. View Record in Scopus | Cited By in Scopus (127)

[20] D.C. Hatton, J. Harrison-Hohner, S. Coste, V. Dorato, L.B. Curet and D.A. McCarron, Symptoms of postpartum depression and breastfeeding, J Hum Lact 21 (2005), pp. 444–454.

[21] K.A. Yonkers, S.M. Ramin, A.J. Rush, C.A. Navarrete, T. Carmody and D. March et al., Onset and persistence of postpartum depression in an inner-city maternal health clinic system, Am J Psychiat 158 (2001), pp. 1856–1863. View Record in Scopus | Cited By in Scopus (86)

[22] Sherman C. Breast-feeding may halve the risk of postpartum depression. OB/GYN News July 15; 2002.

[23] V. Sharma and C.S. Corpse, Case study revisiting the association between breastfeeding and postpartum depression, J Hum Lact 24 (2008), pp. 77–79. View Record in Scopus | Cited By in Scopus (3)

[24] V.L. Susman and J.L. Katz, Weaning and depression: another postpartum complication, Am J Psychiat 145 (1988), pp. 498–501. View Record in Scopus | Cited By in Scopus (22)

[25] Pipitone RN, Leadholm K, Carrone KJ, Gallup Jr GG. Postpartum depression: bottle feeding simulates child loss. Paper presented at the annual meeting of the Northeastern Evolutionary Psychology Society. Oswego, New York; 2009.

[26] J. Kaplan, Responses of mother squirrel monkeys to dead infants, Primates 14 (1973), pp. 89–91. View Record in Scopus | Cited By in Scopus (3)

[27] Y. Warren and E.A. Williamson, Transport of dead infant mountain gorillas by mothers and unrelated females, Zoo Biol 23 (2004), pp. 375–378. View Record in Scopus | Cited By in Scopus (1)

Corresponding author. Tel.: +1 518 442 4852.

Medical Hypotheses

Volume 74, Issue 1, January 2010, Pages 174-176

The Importance of Breastfeeding – From the Baby to Society

January 29, 2010

The Importance of Breastfeeding

The newborn and young baby

Breastfeeding is vitally important for the young baby. It is how babies were designed, through millennia of evolution, to be fed, and as such is perfectly tailored to their needs. It provides perfect nutrition, presenting all the necessary components, and delivering them in the most bio-available way. It provides antibodies, protection from disease that helps to support the baby’s immature immune system. Other physical benefits are clear, though the mechanisms are not yet fully understood, for example the much lower rate of SIDS among breastfed, as opposed to artificially-fed, children. The influence of breastmilk on a child’s health is long-term – children breastfed even for just the first few months have much lower rates of diabetes, obesity, and some forms of cancer, even years later and on into adulthood.

Psychologically and emotionally, breastfeeding can be the basis for a strong, secure bond between mother and baby. This bonding provides the infant with a sense of security, reassurance, and comfort. Although secure bonding is not absolutely dependent upon breastfeeding, the act of breastfeeding does release certain hormones in both mother and baby (specifically, oxytocin), which are often referred to as the ‘love hormone’ and can help induce feelings of calm, peace, and affection. Many studies have researched the link between a secure mother-child bond, and the child’s emotional development later in life. It seems that such a secure bond is the foundation on which all relationships are based, so breastfeeding can be extrapolated to be an important part of learning social skills.

Other social factors may be a bit less clear from the infant’s point of view, but one interesting interpretation is provided by Dr. Brian Palmer, in his presentation ‘The Importance of Breastfeeding as it Relates to Total Health’[i]. The graphic demonstrations of how artificial teats can deform oral and facial characteristics are shocking, and have clear implications for health, but also, I think, have a social aspect. In a society that puts so much emphasis on physical appearance, sucking on a breast will produce more natural facial characteristics, whereas sucking on artificial teats often leads to maloclusions, gapped teeth, and unsightly overbites.

Environmentally, artificially fed infants are at a greater risk of being exposed to environmental contaminants. These can come in the constituents of the artificial milk, the packaging of same, the water used to make up feeds, or leaching from plastic bottles and teats. Exclusive breastfeeding protects from all of these.

Economic factors for the baby relate closely to health issues, particularly at the lower end of the socio-economic scale. Being born into poverty – in any nation, no matter how developed – puts you at a much greater risk for all sorts of health problems. Put simply, if you’re poor you’re more likely to be unhealthy. But breastfeeding can effectively undo a lot of this injustice, with its immense positive impact on early years health. Basically, breastfeeding lifts a poor baby out of poverty in the first, vital months, giving it a flying start that will have a positive health impact for years, overcoming many of the negatives due to socio-economic status in an unjust society.[ii]

The Mother

Mothers who breastfeed have a lower risk of some forms of cancer than mothers who do not, and the risk is reduced proportionally in relation to the total length of lactation throughout a mother’s life. Breastfeeding mothers also have better bone density and a lower risk of osteoporosis later in life, and may lose weight more quickly in the post-partum period. Breastfeeding exclusively for at least six months also means a woman is unlikely to ovulate and menstruate in that time, and unlikely to conceive. Reducing the number of menstrual cycles can reduce the risk of anemia, and increased child spacing is an important factor in women’s health (because many, closely-spaced children exact a huge toll on a woman’s body).

Psychological and emotional issues around infant feeding from the mother’s point of view are numerous, complex, and highly contentious. Few would contest the assertion that breastfeeding is emotionally nurturing for the baby, but many have argued that it is emotionally draining, and sometimes even damaging for the mother, with many others claiming the opposite – that it facilitates bonding and love, and eases the emotional transition into motherhood. Personally, I certainly experienced the latter, but I believe that many women in our society have grappled with the former. However I think that when breastfeeding feels emotionally draining, it often isn’t really the nursing that’s the problem, but rather our social expectations and pressures. Then there is the issue of empowerment – many women describe breastfeeding as the most empowering experience of their lives; knowing that they are able to nurture and grow a baby with their own body is a huge psychological boost. But when difficulties are encountered (often, again, as a result of social conditions, lack of support, etc) a mother can find herself feeling defeated. This only serves to reinforce the need for support for the breastfeeding dyad at every level of society.

More has been written about the social difficulties associated with breastfeeding, than about the social importance of it from a mother’s point of view. But as one of the major factors influencing whether a woman will breastfeed is whether she herself was breastfed, and how many women she has seen breastfeeding – aunts, cousins, friends – it could be argued that each mother who breastfeeds is herself socially important, as she helps to normalise it and pass on that positive influence to her children and everyone around her.

The major environmental concern with breastfeeding from a mother’s point of view is broadly similar to that of society as a whole – breastfeeding means less waste and less pollution than artificial feeding, which means a better environment for her children’s future.

Some economic concerns are obvious: breastfeeding is free. Others are less so: many mothers feel that breastfeeding negatively impacts their ability to participate in the wage economy, either because they do not have enough paid maternity leave, cannot take the breastfeeding breaks to which they are entitled upon their return, or cannot leave their children with other carers, or take them into the workplace. These issues need to be addressed at a societal level – more needs to be done to ensure that breastfeeding in no way limits a woman’s economic options. There is also the issue of class and socio-economic status – in Western society, poorer women are much less likely to breastfeed than richer women. As discussed in the baby section above, breastfeeding helps to cancel out socio-economic inequalities in terms of the child’s health, but this also applies to the mother to a certain extent.

The Father

The father also benefits by his child being breastfed. On the one hand, there is the fact that his child will be healthier, and therefore a stronger inheritor of his genetic material. On the more immediate side of things, a healthy, calm baby means that the father will probably get a decent amount of sleep, and not have to take many days off work to help care for an ill child.

People sometimes object to breastfeeding on the grounds that it excludes the father as he cannot participate in feeding, but this is short-sighted. In fact, fathers of breastfed children can bond very closely with their babies, because they may make a special effort to find a way to bond outside of feeding. There are many things a father can do to support the mother and care for the breastfed infant.

Socially, fathers as well as mothers can welcome the minimal disruption presented by breastfeeding. Many family social activities can continue as normal, with a nursling in tow, so fathers can still enjoy outings and socialising.

Environmentally, again, breastfeeding produces much less waste and pollution which obviously benefits the father along with everyone else. It also means fewer bins needing to be emptied!

Economically, we again have the fact that breastfeeding is free, and also that a breastfed baby is likelier to have fewer illnesses than an artificially-fed baby, so there is less disruption to normal family life and work patterns.

The rest of the family (siblings)

Children in the family benefit by their siblings being breastfed. Physically, if the baby is breastfed, and therefore healthier, then it is less likely to pass on illnesses to other children in the house. Also, a healthy, satisfied baby will leave the parents with more time to devote to other children.

Parents are sometimes worried that older siblings might be jealous of a breastfed baby, but the reality is usually quite different. Especially (though not exclusively) if the older child was breastfed into toddlerhood, he or she is likely to see breastfeeding as a good way for the mother to comfort and care for the sibling, and often suggest it when the baby cries. Seeing siblings being breastfed lays the fundamental understanding of the normal way to care for a baby, as opposed to being indoctrinated by society’s vast array of images of bottlefeeding.

Socially, children who grow up around breastfed siblings may have keenly developed senses of empathy and compassion, as they see the close relationship of the breastfeeding dyad. And these children are also receiving important education about childrearing which will have a profound impact on the choices they make and the sorts of parents or supporters they will become.

The breastfed toddler and pre-school child

All the amazing physical benefits of breastmilk do not, contrary to some information, magically evaporate at the age of 6 or 12 months. Everything that was amazing and good about it for a young baby, is still amazing and good for an older one. Although obviously older children will not be relying on breastmilk for all their nutritional needs, it can still provide a nutritional boost – especially when they are ill or teething and eating less than normal. Many studies show the continued benefits to the immune system of nursing beyond one year[iii]. Nursing beyond babyhood also helps create ideal facial and dental structures, particularly wide upper dental arches which can lead to reduced need for orthodontic treatment, among other benefits.

Arguably the most important aspect of breastfeeding for the toddler is the psychological and emotional support and comfort it offers. For many children and mothers, nursing remains the ‘magic bullet’ that can sooth away tiredness, hurt, emotional upset, and illness. Continued breastfeeding maintains a physical closeness that can help strengthen the emotional bond, and can help mothers to be intuitively responsive to their growing child’s emotional needs. Toddlerhood is such a turbulent time, as children are just beginning to learn about their emotions and how to deal with them, and the security and continuity of a continued breastfeeding relationship can help provide stability and balance. Leaving the timing of weaning up the to child also places trust in him; trust that he knows best what his needs are and how to fill them. Allowing him the power to manage this life-changing time at his own pace can help him build self-esteem, rather than feeling rushed.[iv]

Socially, benefits include the fact that breastfed children may be better at regulating their emotions (as described above), and in any case have a good way to calm down in most situations. These children will also, like those above who are siblings of nurslings, be socially important themselves, as they can have a positive impact on our breastfeeding culture, both as children and as they grow up.

Economically, breastfed toddlers still save their parents money in the form of fewer illnesses and less disruption to family life and work.

Society as a whole

Humans are social animals, meaning we have evolved to live in groups in which we depend upon one another to meet our basic physical and emotional needs. Breastfeeding developed alongside our social evolution, as an integral part of the setup. By helping to ensure the good health of both babies and mothers, breastfeeding helps society – when its members are healthy, a society is stronger. In our society this translates specifically into fewer costs for the healthcare system, and therefore for taxpayers and employers.

Breastfed children may also have stronger, more secure bonds with their mothers, which help establish their behaviour patterns and social skills. Happy, secure children grow up to be happy, secure members of society. They are also more likely to breastfeed their own children, or help support their partners to breastfeed, meaning that future generations reap the rewards.

As mentioned above, the environmental impact of not breastfeeding is huge. If more babies were breastfed, we would hugely reduce pollution and waste. Artificial feeding creates pollution by supporting the industrial dairy industry (livestock is responsible for more greenhouse gas emissions than are vehicles), requiring vast networks of factory production and long-distance transportation (both heavy consumers of fossil fuel, and polluters of water resources), and in the packaging (mostly plastic, with some metal, all requiring huge amounts of fossil fuel, and nearly all of which will be dumped into landfill to leach into the water supply). Given that breastfeeding is the ultimate in ethically, locally produced food, it seems madness to disregard it in favour of something so unsustainable and out of touch with the needs of both society and the individual. Breastfed children have a head start in understanding where their food comes from and how it is produced.


[i] http://www.brianpalmerdds.com/pdf/section_B.pdf

[ii] http://www.theecologist.org/trial_investigations/268337/breastmilk_vs_formula_food.html

[iii] The Breastfeeding Answer Book, pp 202

[iv] Ibid, pp 203

Factors which help and hinder breastfeeding

January 29, 2010

Factors which help and which hinder breastfeeding

Broad Social Factors

In our, western, society, there are some broad social factors which have a huge influence on whether a baby will be breastfed. Some of these are:

  • Socio-economic status of the mother and her family. Put simply, the poorer a mother is, the less likely she is to breastfeed. This is a complete reversal of trends of previous centuries – when rich women had their babies wetnursed, and poor women fed their babies themselves. It is a trend that has been clearly observed since the UK began making detailed surveys on infant feeding in 1975. It is usually attributed to lower socio-economic status being associated with lower levels of education and therefore assumed less understanding of the benefits of breastfeeding. There are clearly other issues at play as well, since use of artificial milk actually began in the wealthier classes, but has ‘trickled down’. Although more research needs to be done to understand the reasons behind this factor, it is acknowledged as a fact by everyone working in breastfeeding support.
  • Mother’s educational level. The higher the level of education attained, the more likely a mother is to breastfeed – this is closely related to the point above.
  • Mother’s occupation and working life. Occupation is also related to socio-economic status – those in professional and managerial roles are more likely to breastfeed than those in manual jobs. But the age of her baby when she returns to work, how many hours per week she returns to work, and whether her workplace offers any facilities for breastfeeding breaks or expressing, also influence the duration of breastfeeding.
  • Mother’s age. Young mothers under 20 are least likely to breastfeed in the UK (less than 51%), while those over 35 are most likely to (84%).
  • Birth order. First time mothers are more likely to breastfeed than mothers having a second or subsequent child, although mothers who had a successful experience feeding a first child are likely to initiate breastfeeding subsequently.
  • Mother’s ethnicity. In the UK, it has been found that about three quarters of white mothers initiate breastfeeding, while the rates for all other ethnic groups are about 9 in 10.[i]

Before and During Pregnancy

One of the main indicators of whether a mother will choose even to try breastfeeding (and then if she does, whether she will be ‘successful’) is how much exposure she has had to it in her life, particularly whether she was herself breastfed. One oft-quoted reference is that most women have decided by the age of sixteen whether or not they will breastfeed prospective children. So, one of the biggest ways to help lay the groundwork for successful breastfeeding pre-delivery is for the mother to have lots of contact with breastfeeding mothers and babies. This will do three things: first, she will learn more about the mechanics of how it works – what a good position and latch can look like. This is the way that breastfeeding was learned in pre-artificial-feeding societies, and remains the norm in many cultures; women learn ‘by osmosis’, unconsciously, by watching breastfeeding happen as part of daily life. Second, it will give the mother confidence in the process – she will see that it works, that babies are happy and healthy, and that the mothers are too. This will help to dispel many of the myths our society has created that discourage breastfeeding. Three, knowing other breastfeeding women will provide the mother with a support network, the pre-existence of which is invaluable should she encounter difficulties. Many women find it much easier to talk to a friend whom they know has had similar experiences, than to phone up a stranger.

The flipside to this is that if a woman has not had a lot of contact with breastfeeding throughout her life, it is likely that she’s been exposed to a lot of myths and unhelpful stereotypes about breastfeeding, which can have a very negative influence on her desire to try it, and her chances of success if she does. For example, some popular culture myths about breastfeeding are (just to name a few): that it always hurts, that the baby is always hungry until the ‘milk comes in’, that breastfed babies do not sleep as well as artificially-fed babies, that it will make her breasts saggy, that there is a high probability she won’t have enough milk. All of these and more may be passed on by mothers and grandmothers, friends, television programmes, and articles in baby magazines, and unfortunately sometimes health professionals. Simultaneously, this mother is receiving a flood of positive information about artificial feeding – that formula fed babies sleep better, gain weight better, that artificial feeding is more convenient and less of a strain on her. And these usually come with insidious attacks on breastfeeding that undermine confidence in it and can seriously hinder successful breastfeeding.

I personally feel that education and preparation for breastfeeding, during pregnancy, can have a significant positive influence. Education can overcome many of the popular myths that are just simply untrue. Surveys have also demonstrated that mothers choose to breastfeed at least in part because they are aware of the health benefits of breastfeeding; therefore it is important that all expectant mothers be given accurate information on the health implications of their feeding choice. The Infant Feeding Survey has also shown that there is a high correlation between intention to feed and initiation of breastfeeding, and further, that women who discussed feeding choice at antenatal appointments and antenatal classes were more likely to intend to feed.

Preparation – talking about good positioning and latch, and watching other mothers feed – will give a mother an idea of what to aim for. And having realistic, accurate ideas of what to expect is key – that breastfeeding is a learned skill for both parties, so just because it may not ‘click’ straight away, doesn’t mean it won’t work, or that feeding for long periods is very normal in a newborn and not an indication that anything is wrong. Women who are armed with this information ahead of time seem more likely to carry on breastfeeding, and to seek help when they need it, than women who just thought it was all supposed to work and then may get flustered when it needs a bit of tweaking. I think this sort of preparation can be delivered either in a formal breastfeeding setting such as a breastfeeding preparation class (run on some NHS and NCT antenatal courses) or attending an LLL meeting, or in less formal settings such as baby cafes and drop-ins that welcome expectant mothers.

Labour and the first 24 hours after birth

One of the biggest issues during labour that can affect breastfeeding is the use of drugs and painkillers. Studies have concluded that mothers who receive pethidine, particularly if it is given close to delivery, give birth to babies with a higher likelihood of sucking and rooting problems, including more crying, fewer breast-seeking behaviours, delayed and depressed rooting, and less sucking. One study found that babies of mothers who received an epidural during labour were less alert, less able to orient themselves, and had less organized movements at the breast, and that these differences were measureable throughout the entire first month of life.[ii]

Apart from drugs, physical interventions (which frequently go hand-in-hand with the drugs) can hinder the establishment of successful breastfeeding. Babies delivered by ventouse or forceps may suffer head or neck trauma that can make it painful to feed.

Cesarean section birth presents a range of potential hinderances to breastfeeding, but it is important to keep in mind that successful nursing remains possible and desirable, no matter how the baby was born. If a general anaesthetic was used, the mother may be unconscious for some time, which can delay the first breastfeed. However many c-sections can be performed with a regional anaesthetic, after which the mother should be able to breastfeed very soon, either in theatre or in the recovery ward.

With any hospital birth, but more so with c-sections and very medicalised births, another potential pitfall is separation of mother and baby. One study found that separation for as little as 20 minutes immediately after birth led to a dramatic fall in effective first feeds. Other studies have linked early separation with shorter overall duration of breastfeeding.[iii]

Modern practices also advise a range of potentially painful procedures for the baby, which can interfere with feeding. Particularly problematic is vigorous suctioning of the mouth and throat – sometimes necessary if the baby has breathing difficulties but sometimes still performed routinely – which can lead to a sore throat and injured vocal cords, making sucking painful. Other procedures include heel sticks, injections, spinal taps, or circumcisions – all of these are painful and may make a baby unreceptive to breastfeeding. However, nursing through these procedures has been shown to have a powerful analgesic effect.[iv]

Finally, the hospital environment in which most women in our society give birth can itself be non-conducive to successful establishment of breastfeeding. What should be an intimate, private bonding moment between mother and baby is all too often rushed, under harsh lights and the interfering stares and interventions of medical personnel – this is not the ideal first-feed scenario. Then, in the hours and perhaps days after birth if the mother remains in hospital, she may have to battle to keep her baby with her, and she will almost certainly be kept awake by the lights, other people, hospital routines and noise… And many hospitals still give babies supplemental bottles, sometimes even against parental wishes. But many women do successfully breastfeed after giving birth in hospital – let’s go back to the beginning.

Ideally, a woman will have thought about breastfeeding and prepared during pregnancy, learning about good positioning, what to expect from her newborn and from herself, and will have written a birth plan that takes into account how best to establish breastfeeding. Not every birth goes to plan, of course, but understanding ahead of time how different scenarios affect breastfeeding can help the mother prepare for whatever happens. Giving birth naturally and without painkillers is the ideal, from the perspective of establishing breastfeeding. When natural childbirth goes well, hormones are released in both the mother and baby that help emotional bonding, and stimulate the rooting and sucking reflex in the baby and the let-down reflex in the mother. These hormones will also help the mother’s uterus to contact – particularly helpful in the case of a c-section delivery. In almost all births, the baby can be delivered straight onto the mother’s stomach. If alert and well, the baby may be left to ‘breast-crawl’ – an amazing feat in which the newborn makes his own way to the nipple! Otherwise the mother can bring him to the breast for the first feed – preferably within just a few minutes of birth. This immediate skin-to-skin contact is vital for the baby’s health, and not only in terms of breastfeeding but also because it helps him regulate his body temperature, and makes sure his skin is colonised by the same bacteria as his mother’s  which some studies suggest can aid in bonding.

The mother may like some guidance at this point, but any assistance should be sensitive and subtle, to help mother and baby get themselves into a good position and attachment, rather than roughly doing it for them. Once a good latch has been achieved, the pair should be left undisturbed for as long as they both want. This is the basic tenant of establishing successful breastfeeding in any circumstance – breastfeeding should be unrestricted and undisturbed, with no limits on frequency or duration of feeds, and intervention only when required and requested. Feeding should be encouraged to happen every 1.5 – 2 hours, if the baby is not already requesting it himself, to avoid dehydration and prevent him from getting frantically hungry, which can make getting a good latch more difficult.

Qualified help should be available to ensure that the latch is good, and provide support if it is not. Midwives, while they have a lot of experience in seeing women breastfeed, often have no actual breastfeeding-specific qualifications, and many have not breastfed their own children. This is why qualified support is so important – mixed messages, however well-meaning, are confusing and detrimental. The help of a well-informed and supportive partner or friend is also invaluable.

Mother and baby should not be separated, and should be allowed to share a bed, safely, if the mother wants to do so. Except in cases of clear medical necessity, the baby should not receive anything other than breastmilk – no supplements of artificial milk, water, or anything else. Where it is medically necessary, supplementation is best offered by means other than a bottle, such as cup or syringe feeding, and preferably by the mother herself or the father. Pacifiers or soothers should be avoided.

To summarize, many things about modern labour, childbirth, and the immediate post-partum period can negatively impact on breastfeeding. The best ways to support the establishment of successful nursing are:

  • good preparation and realistic expectations
  • as natural a labour and childbirth as possible
  • skin-to-skin contact as soon as possible
  • no separation of mother and baby
  • unrestricted, frequent breastfeeding
  • no intervention (supplements, etc)
  • qualified, sensitive support when required.

First month

Although initiation rates of breastfeeding may seem high (78% in England)[v], these rates drop dramatically, with the sharpest decline happening in the first 2-6 weeks of life – by six weeks, the figure is about 50%. This refers to babies receiving any breastmilk. Among mothers who initiated exclusive breastfeeding at birth, the sharpest decline was also seen in the first weeks, leaving just 32% of those babies still exclusively breastfed at six weeks old. What is happening in this first month that has such a deleterious effect on breastfeeding?

Many respondents to the Infant Feeding Survey cited insufficient milk supply as a reason for stopping breastfeeding in the early weeks. As this was a mother questionnaire, it is impossible to know whether they really didn’t have enough milk, but given that only 1-2% of women are physiologically incapable of sufficient milk production, it seems logical to conclude that a large proportion of these women were either misinterpreting the situation (ie, they really did have enough milk, but believed they did not), or that they had insufficient supply due to poor breastfeeding management. The survey also noted that by far the highest proportion of women experiencing feeding difficulties in this period were those who were mix-feeding, breastmilk and supplements. It was not clear whether supplements included expressed breastmilk fed via bottle.

It is very noticeable that in our society there is, immediately after birth in most cases, a huge push to ‘get back to normal’. Parents both seem to think that after a brief period of adjustment, their lives will more or less return to what they were before, only with a baby there as well. Mothers have the added pressure to return to their pre-pregnancy shape and weight. This has contributed to the huge popularity of proscriptive baby-care regimes, which dictate tightly controlled feeding and sleeping times, and so on. All of this is detrimental to the establishment of successful breastfeeding, which requires the demand-and-supply approach of on-cue feeding and relying on the baby’s and the mother’s instincts more than the rule book. But because babies ‘haven’t read the book’, mothers fret that they aren’t getting enough milk – because they are hungry again before their four hours are up, or because they have had their allotted ten minutes of feeding but aren’t satisfied, or because they don’t sleep for as long as expected, or at the ‘right’ times. Because of a wealth of misinformation, many mothers conclude that a baby is unsettled because she doesn’t have enough milk, or because it isn’t good enough. This can lead to supplementation with artificial milk. As soon as supplements are introduced, the demand-and-supply cycle is disturbed, and the risk of supply dropping actually increases. Mothers who are mix-feeding are also at a higher risk of engorgement and blocked ducts, which have themselves been cited as reasons for stopping breastfeeding.

I feel the need to make special note of the current fad for feeding expressed breastmilk via bottle. While still not as popular here as it is in the US, this seems to be gaining in popularity and I find it alarming. There seems to be an serious misunderstanding that the milk is the most important factor in breastfeeding, and therefore bottlefeeding EBM is just as good as breastfeeding from the source. This is simply untrue. Bottlefeeding EBM can still interfere with a mother’s supply, because a pump will never be as efficient as a baby at extracting milk and stimulating supply, not to mention the emotional bonding process which is lost when silicone and glass replace your baby. No matter what is in the bottle, nipple confusion is a real possibility, especially in the early weeks. But rather than discuss at length the reasons not to routinely bottlefeed EBM, we should just point out that there is almost never a good reason to do it, so why would you? Parents often cite the father’s desire to bond with his baby, but people who know babies well know that feeding is only one area, and there are many ways a father can bond closely with his new baby that do not involve a bottle. There are also other ways to help a new mother out and ‘give her a break’.

Even among mothers who do not give supplementary artificial milk or EBM, many mothers are still trying to get their babies onto a strict routine in the early weeks. This is at odds with a baby’s natural pattern of behaviour as he gets to know the world and gets to grips with organising his feeding. As discussed in the section above, one of the main tenents here is unrestricted access to the breast. Breastfeeding must not be scheduled by the clock, and feeds should not be restricted in frequency or duration. It may help to understand that babies’ patterns are likely to be chaotic and changeable over this period, and that they are unlikely to fit neatly into a timetable. Having a partner, friends, or other support on hand who understands this too and can support the mother during this time is invaluable. A partner who grumbles ‘why don’t you just give him a bottle’, when the baby is yet again awake at 2am is eroding a mother’s confidence. But one who gets up with her, rubs her back while she works to get the baby latched on well, tells her what a great job she’s doing and offers to get her a drink of water, is supporting both the mother and the baby, and supporting the establishment of successful breastfeeding.

This dichotomy between support and lack of support can come from all sides. Older female relatives are a particular pitfall – they may be very supportive, or they may chip in with well-meaning but unhelpful comments (‘I fed all of mine formula and they’re fine’). And of course health professionals play a crucial role at this stage. A well-informed HP who is truly supportive of breastfeeding can be a godsend, but equally, a poorly-informed one can undermine a mother’s firmest intentions, for example by questioning weight gain and the baby’s health, or any one of numerous other all-too-common issues.

Another area of concern in the early weeks is feeding in public. Most mothers breastfeed their babies all over the place with no issues, but unfortunately some do still encounter problems, ranging from a disapproving glance all the way to being ejected from public spaces. Often, it is not an actual experience, but merely the fear of one, or potential embarrassment, that worries a mother, and she usually finds that once she’s got out there and starting breastfeeding in public, things do go smoothly.

The list of top reasons cited by mothers who give up breastfeeding within the first two weeks is: insufficient milk, breast or nipple pain, the baby rejecting the breast or refusing to suck, breastfeeding taking too long or being too tiring, the mother being ill, the mother not liking breastfeeding, ‘domestic reasons’ (not clarified, but one assumes this includes care of other children and household work), the baby being ill, difficulty in judging how much milk the baby has had, and that they could not share feeding responsibilities. What is striking from this list, is how many of these factors could be addressed by having access to trained, dedicated breastfeeding support. The worries over milk supply, particularly, could be alleviated by a better understanding of the process, and most problems with breast and nipple pain can be addressed through adjusting attachment and positioning. But this requires specialist support. Other causes of pain and poor feeding such as tongue-tie are often missed unless the mother consults a breastfeeding specialist but, once diagnosed, can be corrected easily and breastfeeding can be successful. What is also striking is that by far the most common place mothers seek advice when they experience breastfeeding problems, at all stages after the immediate post-partum period, is from their health visitor. Unfortunately, the fact that most HVs do not have specialist training means that all too often these women are not getting the support they need. Trained BFCs and IBCLCs did not even make it into the list of common places for support.[vi]

It seems that mothers who are able to adopt a more relaxed approach to the first weeks and months may have fewer problems with breastfeeding, or may perceive fewer things to be a problem. For example, a mother who expects her 4 week old to sleep from 11-8 perceives a problem of wakefulness and unsettledness when he does not. But a mother who expects her 4 week old to feed off and on throughout the night does not perceive a problem. Similarly, a mother expecting a baby to feed four-hourly may think he is hungry and that her milk is insufficient when he wants to cluster feed in the evening. But a mother who isn’t watching the clock and isn’t concerned about routines may not perceive a problem.

Factors that can help breastfeeding at this stage are co-sleeping – because when the baby is close to his mother at night he is likely to feed more (boosting her supply in the crucial 2-5am window when prolactin levels are highest), and she is more likely to pick up on his feeding cues (meaning he doesn’t go hungry). Babywearing or carrying during the daytime can have similar benefits.

In summary, the first month is full of potential pitfalls for breastfeeding, many of which centre around a mother’s idea of what her baby ‘should’ be doing, and trying to get him into a routine or schedule. Physiological problems such as breast and nipple pain are also common. But mothers who are well supported, by well-informed partners, by family and friends with experience of breastfeeding, and with access to good help to overcome such problems if they occur, are most likely to keep nursing their babies.

One month onwards

All of the factors discussed above still apply after one month and the end of the official newborn period, although as time progresses, women are less likely to cite breast refusal as a reason to stop breastfeeding. Support, or lack thereof, from partners, family, friends, and health workers is still absolutely key in how a mother feels about the breastfeeding relationship, and how it will develop.

There does seem to be a strange idea that the biological benefits of breastfeeding only apply for the first six weeks of life. I personally have even heard a GP say this, that there is therefore ‘no reason’ to continue nursing after six weeks. Such unhelpful and astoundingly wrong ideas can obviously hinder a successful breastfeeding experience, particularly as a mother is most likely to encounter something like this if she has approached a health professional for help or advice. If she has taken this step, it is probably because she is having a problem, in which case she is probably feeling even more vulnerable than the already fragile state many new mothers are in. And so it can be devastating to have the issue made light of. I cannot determine the origin of this particular myth, but the only way to fight it is with education and accurate information and support.

There does seem to be some suggestion that women are likely to feed subsequent children for a similar length of time as first or previous children, so if a mother stopped nursing her first at six weeks, she is more likely to stop feeding her second early, as compared to a mother who fed her first for a longer period. In general, many mothers talk about difficulty in tending to older children’s needs while establishing breastfeeding with a young baby – this seems to be a more frequent issue in families with closer age gaps, where the older child is still quite dependant.

As the baby gets older, the mother is also more likely to face pressure to introduce supplements, and then solid foods. As discussed above, the father may want to introduce a bottle so that he can participate in feeding. Pressure to introduce artificial milk can also come from health professionals, particularly if they are concerned about the baby’s weight gain. This is often a product of outdated information and expectations, comparing breastfed babies to artificially-fed babies who have different weight gain patterns. Pressure to introduce solid foods can begin as early as 12 weeks – though at this stage often comes from older family members (since the official advice used to be to introduce solids at ‘12 weeks or 12 pounds’) who are basing it on their own experience. Pressure for solids increases as the baby gets older, with health professionals often weighing in from 16-20 weeks onwards.

Mothers may also find that as the baby gets older, if they seek support or advice for breastfeeding problems such as thrush, blocked ducts, mastitis, nipple pain, biting or teething, someone who is poorly-informed about breastfeeding may simply advise them to stop as ‘the baby is old enough now anyway’, or similar. More serious conditions such as either the mother or the baby needing surgery or antibiotics, or other drugs, often cause health professionals to advise the mother to wean a baby, though in most cases a way can be found to continue breastfeeding and have treatment.

As the baby gets older, the mother and father are more likely to feel pressure for the baby to be in a routine, and to ‘sleep through the night’. The pressure can be both internal, from their own expectations of what children ‘should’ be like, and external, with people actively telling them what the baby should be doing by now. This is often the point at which parents introduce a bottle of artificial milk at bedtime, in the hopes that the it will help the baby sleep deeper and longer. Obviously, this can interfere with the mother’s milk supply, among other things.

On the positive side, many mothers who have had breastfeeding difficulties in the early days find that things become easier once the baby is a few months old. Slightly older babies are stronger, more able to maintain a good latch, and usually develop more efficient sucking and feeding habits which means that feeds take less time and the mother has more time for other things. She may also have perfected feeding in a sling, so that she can feed and do other things. She’s likely to have gotten to grips with feeding in public by now, so taking her baby out and about with her doesn’t feel so daunting anymore. If she’s listening to her baby and following his cues, she’s probably started seeing some sort of rhythm now, which may help her to feel more confident about understanding his needs and how to mother him. Loving support from partner, friends, and family continues to be really important – especially if they can find ways to help the mother, that don’t involve feeding the baby, such as letting her get some more rest by taking him for a walk. And as ever, it is important to have access to qualified, well-informed support for any problems or questions. Such support should be easy to access, but health professionals in particular should take care to only offer support when appropriate and requested.


[i] Infant Feeding Survey 2005 http://www.ic.nhs.uk/webfiles/publications/ifs06/2005%20Infant%20Feeding%20Survey%20%28final%20version%29.pdf

[ii] The Breastfeeding Answer Book, pp 27

[iii] Ibid, pp 27 and 33

[iv] Ibid

[v] Infant Feeding Survey 2005 http://www.ic.nhs.uk/webfiles/publications/ifs06/2005%20Infant%20Feeding%20Survey%20%28final%20version%29.pdf

[vi] ibid

Not breastfeeding is like mourning the death of a child

January 29, 2010

bottlefeeding mimics mourning

“According to a new theory being proposed by University of Albany evolutionary psychologistGordon Gallup and his colleagues, the decision to bottle-feed is tantamount, in the mother’s psyche, to mourning the loss of the child. At least, that’s how a woman’s body seems to respond to the absence of a suckling infant at its breasts in the wake of a successful childbirth. In a soon-to-be-published article in Medical Hypotheses, the authors argue that bottle-feeding simulates the unsettling ancestral condition of an infant’s death”

This presents fascinating new angle in the quest to have breastfeeding acknowledged, fully and sincerely, as the biological norm against which to judge anything else. However as many of you will know, all too often it is still bottle-feeding of artificial milk that is taken as the norm against which breastfeeding is judged. You will know too of the constant worries about making formula-feeding mothers feel guilty (here is an excellent discussion of that topic). Rather than piling on the guilt or arguing that artificial milk is worse for babies than breastmilk, this article takes an entirely new look at the situation and comes up with a new interpretation. It certainly won’t be easy to hear for some people, but I think it’s well worth reading.

Multinationals running riot in Vietnam

September 20, 2009

Read about yet another case study in just how devious the artificial milk makers are, here