Whilst I appreciate the reason for the sentiment being expressed here (to 
help working mothers cope with the distress they may feel if their babies 
"strike") I don't think that ultimately we do mothers any favours by 
telling them that nursing strikes "just happen".  Why?  Because in my 
experience nursing strikes are always caused by something, and it is our 
job to - gently - help the mother identify the cause so that she can take 
preventive action to avoid them happening again.

The subject under discussion is whether working mothers whose babies have 
bottles in their absence will subsequently refuse the breast.  While I've 
known that to happen, I've also worked with babies who have been 
exclusively breastmilk-fed by bottle for some time, and who subsequently go 
on to the breast and breastfeed effectively as if they've never known 
anything different.  So I don't think that bottles, per se, are the cause 
of most breast refusal.

If you want a baby to breastfeed and *keep* breastfeeding, it seems to be 
necessary to 1) make latching as easy as the baby has patience for 2) 
reward the hungry baby with milk, and 3) make the whole 
mommy-nursing-breastfeeding experience delicious and wonderful from the 
baby's point of view.  A strike in a baby who has been breastfeeding well 
until it happened (for whom 1 and 2 above were not a problem) can usually 
be traced to an insult having occurred with 3.  I've known a baby who 
sudedenly refused the breast because his mother started using a new 
perfume, and many, many babies who become progressively more difficult to 
breastfeed because of a sensitivity to something the mother is eating 
(usually bovine proteins).  But the large majority of nursing strikes are 
caused, IME, by the baby being made to wait too long after exhibiting signs 
of hunger/discomfort, ie the needy baby is not responded to within his 
limit of tolerance.  Often these babies are exceptionally placid and 
easy-going, and I think what happens is that the mother gets used to that, 
and just naturally pushes the baby's boundaries further and further (as we 
do ....)  And then suddenly, there's this rivetting refusal.  Suddenly the 
mother finds that the baby arches and screams whenever the breast is 
offered, and everything becomes very fraught, very quickly.  If you have 
the chance to have the mother show you how the baby behaves it is 
immediately apparent that the baby is completely unwilling to be that 
intimate with the mother any more.  I think it demonstrates that the baby's 
trust has somehow been broken.

My care plan for resolving a nursing strike focuses on repairing the 
mother-baby relationship and re-establishing the trust - from the *baby's* 
point of view.  While comforting the mother and helping her to become a 
willing partner in seducing her baby back to the breast, I sometimes say 
that nursing strikes do happen and sometimes it only becomes apparent 
afterwards what the cause was. I don't dwell on the cause because the 
mother feels bad enough as it is, except to rule out possible infections, 
and anything the mother thinks might be relevant.  Instead it seems to be 
useful to make suggestions to resolve the crisis.   I suggest abandoning 
all other commitments for a few days (difficult for a working mother), and 
keeping the baby in 24-hour body-contact, eg "wearing" the baby while mom 
does everything else, sleeping with the baby, playing with the baby - and 
offering the breast often (as well as EBM in a bottle, if the baby is used 
to a bottle, and other foods and drinks if the baby is used to them too), 
ie keeping the baby as *happy* as possible.  It is stressed that the baby 
needs to be in charge, and she needs to treat him like Dresden china - 
offer to breastfeed in his favourite position, in his favourite place, and 
to try other places and styles too.  And to spend lots of alone-time with 
the baby - she is attempting to seduce him.  If he refuses the breast the 
mother mustn't force, even slightly.  If he takes even one tentative suck, 
she is to praise him with big smiles. Once he starts breastfeeding again, I 
warn her she will have to treat him very carefully for at least a week. 
I've only know one case where this didn't work (where the father refused to 
allow the mother to sleep with the baby!)   All others were resolved within 
24 hours - often much sooner.  What baby can resist this treatment?

The outstanding consequence is that - afterwards - the mother will often 
realize what it was that caused her baby to strike.  She will often 
describe too, how she should have seen it coming, but ignored the 
signs.  But once she has had the experience of making breastfeeding happy 
and wonderful again for the baby, she will often be able to identify that 
it was not like this before the strike.  And, having been humbled by the 
experience, she usually vows not to let it happen again.  In any event, she 
can then recognize the signs of an impending second strike and head them 
off.

If a previously happily-breastfed baby finds that now bottle-feeding is 
easier for him, or for his mother, than breastfeeding, then he will 
intelligently take the line of least resistance.  I think it's necessary to 
warn working mothers who have to leave their babies with bottles, that - if 
they want to maintain breastfeeding - it's vital that they make 
breastfeeding time with their babies consistently "special" and close and 
nyummy, ie *better* than bottle-feeding.  This is not to blame mothers, 
they are doing multiple jobs and never have enough time, but to enable them 
to take avoiding action.

In an ideal society babies would be so valued that mothers' job of 
mothering them would be given top priority, which would include being with 
them for at least two years so that nothing would interfere with 
breastfeeding...... Meanwhile, there are so many things which are seen to 
be much more important than attending to babies - and so we have pacifiers, 
and nipple-confusion and nursing strikes.  Oh well ........

Pamela Morrison IBCLC
Rustington, England
[log in to unmask]

13:19 21/10/2005
>And I think a big psychological boost to working moms is to let them know that
>nursing strikes are relatively common, that they happen to moms who are home
>all day, who never give a bottle - it can just happen - that helps the mom
>realize that while it may indeed be related to giving the bottle - that she's
>not some terrible parent for being away. Mom's have all kinds of reasons for
>going back to work - and it's not our job to question them - just to give them
>the best information we have and support their continued efforts to
>breastfeed.

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