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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