This is in response to Karleen's observation and question, while keeping in
mind Liz Brooks long response based on more recent and current US
experience.
My research advice and beliefs in the twentieth century in Australia has
shown that a recurrent theme in advertising for the many articifial
substitutes for breastfeeding was that the mother's milk supply might fail.
Advertisers knew it was good for sales to appeal to mothers' fears and
existing community beliefs that lactation was unreliable. Fears about the
unreliebility of lactation continue, and - as Liz has written so
passionately - are compounded for US mothers by the sadly early mandatary
return to work, lack of support in the community, at work and elsewhere, and
outright hostility towards them for daring to attempt to maintain their
lactation. With these pressures, Liz explains that desperately pumping is
one response to provide them with reassurance and milk security.
Looking more broadly, there is nothing new about the instruction to mothers
to express their milk to increase or maintain supply. However, when this was
a common practice in England and Australia and elsewhere, mothers used their
hands to express after feeds - they rarely pumped (Thorley, 2012). It is
always a contentious point to try to name "the first" to advocate a
particular regimen. However, while Drs Eric Pritchard and the New Zealander,
Truby King, had previously been influential on infant feeding in Britain, I
believe the impetus in the mid-20th century to advise new mothers to express
after each feed appears to have come Dr Harold Waller at the Woolwich
Hospital in S-E England (Waller, 1946; Waller, 1947; Waller, 1950). Hospital
stays then were long. The Truby King system recommended external
stimulation (breast massage) for low supply, while strictly restricting
frequency and length of feeds (Thorley, 2003). The Queensland (state)
Maternal & Child Welfare system recommended expressing after feeds, but only
in cases of low supply, not for all mothers (Thorley, 2003). Mothers in
other states expressed for a variety of reasons, until this practice fell
from favour (Thorley, 2012).
In an era when restrictive feeding times were unquestioned, Waller saw
hand-expressing as the way to get breastfeeding off to a good start and
support the MER. He implemented hand-expression to prevent what was clearly
engorgement, drain the fattier milk that remained, and safeguard the supply.
He advocated teaching expression antenatally, and hospital stays were 12-13
days, but longer if there were breastfeeding difficulties. I have been
unable to find evidence of any instructions for when to stop. In the
introductory part of a 1947 lecture he talked about dairy cows and how the
milking at set intervals caused excess milk production and the stretching of
the cows' udders, and he also described his observations of sheep in the
field and the lambs' response to the MER. Although he described the very
frequent feeding by the lambs, he didn't apply this to human lactation. The
milking of dairy animals seems to have influenced his thinking.
Other systems also used expressing after feeds in the 1960s and 1970s,
whether influenced by Waller's Woolwich methods or local adaptations of the
Truby King system. These were systems in which the 4-hoursly schedule was
considered sacrosanct and the length of the feed restricted, too. Back in
1965 in the after-care Maternal & Child Welfare hospital, I myself was
forced to express after each feed in my first baby's early weeks and the
mothercraft trainees did hot-and-cold-splashed and breast massage for
external stimulation, but my supply continued to decline. Why? - because my
baby was kept in the nursery or shut in the Matron's office, to which I had
no access, and she screamed for about 45 mins before each feed. After
unsuccessful feeds by an exhausted, sleepy baby, she was topped up by bottle
and I expressed, hardly anything. It didn't help that come staff made
negative comments, including that I was a bad mother who "didn't love [my]
baby", because "if I loved her" I'd have her exclusively on the bottle. That
really hit my MER!
Heroic methods to maintain lactation are used when access to the breast is
restricted (whether by hospital regimens or long working hours). In the
mid-nineteenth century, under the gang system of agricultural labour,
mothers were obliged to be away all day in distant fields, with no access to
their babies. To keep the babies calm, they left opiates in the rags the
babies sucked on. Opiates were commonly used in England for babies by the
urban and rural poor, usually in "soothing syrups", for a variety of reasons
(Phillips V, 1978).
My references are below.
Virginia Thorley, OAM, PhD, IBCLC, FILCA
Cultural Historian of the History of Medicine
Brisbane, QLD
References:
Phillips V [Thorley V]. Children in early-Victorian England: infant feeding
in literature and society, 1837-1857. J Trop Paediatr Envir Child Health
1978 (Aig): 158-166.
Thorley V. Printed advice on initiating and maintaining breastfeeding in
mid-twentieth century Queensland. J Hum Lact 2003;19(1):77-89.
Thorley V. Human milk use in Australian hospitals, 1949-1985. Breastfeeding
Review 2012; 20(2): 13-23.
Waller H. Arch dis Childhood 1946; 21; 105.
Waller H. Some clinical aspects of lactation. Arch Dis Childhood [1947?]:
193-199.
Waller H. The early yield of human milk, and its relation to the security of
lactation. Lancet 1950; I: 53-56.
~~~~~~~~~~
Karleen wrote:
I'm just writing up some research and am somewhat puzzled by some mother's
descriptions of how they came to have excess milk to donate to another
mother. There were a significant number who said that they had excess
expressed milk because they needed to pump to maintain their milk supply. I
thought that this might be the first time this was described but, no,
Osbaldiston, R. and L. A. Mingle (2007). "Characterization of human milk
donors." Journal of Human Lactation 23(4): 350-357; quiz 358-361. also found
a significant % of mothers donating to a milk bank who "had to pump to
stimulate lactation" and these mothers were large volume donators.
I'm very interested in people's experience with this phenomenon. I think
that some of these mothers' beliefs about the need to pump may come from
popular books which insert pumping into a breastfeeding mother's schedule
for the purposes of ensuring that there is enough milk. I wonder how
commonly LC and peer counsellors are seeing this and, have any of you come
across a mother who needed to do such a thing to be able to breastfeed her
baby- I can't think of a mechanism by which this would be necessary!
Osbaldiston et al suggested that such women should be targeted as milk
donors! Not my first thought for an appropriate response!
Karleen Gribble
Australia
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