Karleen, and Marit and Rachel,

I absolutely agree with Karleen here.  Breastfeeding is not always 
easy and enjoyable at the beginning, although it usually becomes so - 
like anything else - with competence.  But if it's presented as 
something that the _baby_ needs (like comfort, clothes, being kept 
clean) then it's easier to advocate for.  In the hospitals in 
Zimbabwe all mothers were more or less forced to begin breastfeeding 
because formula was simply not available without clear medical 
indication, and then in the least amount, for the shortest possible 
time.  I had many mothers in my antenatal classes from ethnic groups 
where bottle-feeding was seen as perfectly normal express alarm about 
this - in fact I think they often only attended the breastfeeding 
class so that they'd be able to "get through" the first few days in 
the hospital, when they planned to go home and put the baby on the 
bottle.  However, it was amazing how many mother became "hooked" on 
breastfeeding in those first few days.    And how the "pressure" to 
continue breastfeeding after hospital discharge gradually lengthened 
the time to weaning. For instance, all the paediatricians just 
promoted breastfeeding as a matter of course, and would refer mothers 
who were having problems to an LC.  So the mother would have to find 
someone else to help her bottle-feed, maybe going back to her GP 
instead.  But several of the GPs would insist that the mothers 
breastfed for at least the first six weeks, to get the baby off to a 
good start, and so the mothers complied.   By six weeks the babies 
were usually breastfeeding well, so the mothers would often go a bit 
longer, and a bit longer - and then influence their friends and 
relations later.  Over the years, I saw a ripple effect, with weaning 
to the bottle going up from 3 days to 6 weeks for even the most 
marginally motivated mother, and as I say, many, many of those who'd 
originally intended to wean early found that they loved breastfeeding 
once they could do it, and carried on .... and on .......which, 
ultimately, is very empowering for women.

Our task, I think, is to work at shifting the emphasis from What 
Women Want, to What the Baby Needs.   Also, from a purely rational 
human rights approach, this will help us work towards a better 
enabling environment for mothers - including Baby-Friendly hospitals, 
endorsement of LC consults, mother-support group referrals, 
implementation of the Code, a better deal for working mothers, and 
protection of mothers breastfeeding in public.

Just reading Rachel's and Marit's very perceptive messages, 
particularly their concern that the baby will feel the mother's 
negativity, I'm not sure how valid this is.  Is it better to 
bottle-feed with love than breastfeed with reluctance?  Better for 
the baby???   I've often had mothers express the worry that their 
baby's "colic" (irritable persistent crying with no known cause) 
might somehow be due to their own emotional stress.  And some of them 
may then cite this as a reason for weaning because "It''s not good 
for the baby and it's not good for me".  I'm not sure I buy 
this.  Breastfeeding _is_ good for the baby, no matter what might be 
going through the mother's mind.  Babies are too selfish, and/or too 
inexperienced to notice what the mother is feeling so long as they 
have unlimited access to the breast.

On the other hand, I've worked with mothers in the first couple of 
days postpartum (called by nursing staff, ostensibly due to severe 
latching difficulty) and observed that sometimes the mother becomes 
jerky and quite rough and will often deliberately sabotage latching 
so that breastfeeding becomes literally impossible.  Some of these 
mothers started out providing EBM, because they had to, and then 
became very eager to provide expressed breastmilk for many months - 
ie they still wanted the "best" milk for the baby, even if they 
couldn't bring themselves to actually breastfeed.  Some told me 
afterwards that breastfeeding made them want to "just throw the baby 
across the room" and they could only love the baby once they put the 
baby on the bottle.  Perhaps this warrants referral to a psychologist 
- nevertheless, the baby ends up being breastmilk-fed, and the mother 
has the advantage of the normal postpartum hormonal profile of 
draining milk from her breasts on a regular basis, which I'm positive 
helps her to remain really tuned in to her baby.  Some of them will 
breastfeed a subsequent baby direct.

As to such a mother's unwillingness for intimacy, it's impossible not 
to wonder how a woman "endures" the intimacy of conception, yet 
apparently rejects the intimacy of breastfeeding the baby.   I think 
this history may be "hidden" to a certain extent in countries where 
mothers are actively encouraged to choose their own feeding 
method.  But in countries where all mothers are just normally 
expected to breastfeed, and receive unlimited help to do so, you 
start to see mothers who can't rely on the usual reasons for 
bottle-feeding, so as Rachel and Marit describe, you may see a higher 
number of mothers who seem to "endure" breastfeeding.  Does the 
mother of a breastfed premature baby ultimately not feel proud of 
what she did for the baby, even though she felt "forced" to do 
it?  Would this baby _really_ have been better off bottle-fed with 
love?  Should we agree that the mother's feelings of victimization 
are more worthy of being attended to than her baby's need for her 
milk?   In African cultures where sexual abuse is just as, if not 
more common, than in Europe and N America, breastfeeding is seen as 
so normal that a history of sexual abuse would never be used as a 
reason not to breastfeed.  So is it a cultural construct?

How much validity should we accord maternal unwillingness to 
breastfeed?   I don't know.   In our freedom-loving, 
happiness-seeking cultures we can not only afford to "allow" mothers 
not to breastfeed, but we also, amazingly, feel an obligation to 
support them in their choice.  But we need to remember that this is 
only because we have such sophisticated medical care that we can get 
away with it - most of the time.  It seems impossible to believe that 
industry have not had at least some input into the way infant feeding 
choice is framed, and have succeeded in influencing our attitudes 
towards it.   If a mother tells me she doesn't want to breastfeed, I 
always feel infinitely sorry for her, because she's completely missed 
the point.  At the same time, I always feel a clutch of fear for the 
baby.  I don't see how we can ever reconcile this conflict of interests.

Pamela Morrison, IBCLC
Rustington, England
---------------------
Hi Marit,
I think it's good for mothers to enjoy breastfeeding but I don't see a
problem if they don't. There's lots of babycare that's usually done as an
obligation (like changing nappies for instance) because it's what babies
need. Why should breastfeeding be any different?
Karleen Gribble
Australia

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