Here is another take on the connection between breastfeeding and full time mothering vs.working in an environment that requires maternal infant/child separation.  

As many of you know, I research the psychology of issues related to birth, breastfeeding, parenting and early childhood. My clinical work also focuses on the psychological aspects of family life. In order to understand the interplay between my areas of interest and psychology, I have to understand basic psychological theory and then apply them to my area of interest. 

Let's see how relational theories inform our view of maternal infant/child separation and development and then we can apply this to the nursing couple. Relational theories seem to indicate that the relationship between the primary caregivers (i.e. mothers) and offspring, is unique and dictates the quality of development in several realms. We see for example, that mothers, especially those who are well supported by their environment, seem to develop an  ability to interpret and respond to their children in a manner that accurately matches the children's needs. This characteristic also seems to depend on mothers' own experiences of being heard and responded to, in the past and present. 

In optimal situations, the interactions between the primary caregiver evolve and change to reflect the novel developmental capacities of the child.  For example, in the early stages of post natal life the infant looks to the primary caregiver to fulfill their basic needs. In some theories basic needs include the provision of life enhancing substances and in other theories for example, the primary caregiver assists the infant in making the transition from a body connection to mother to a separate identity. As children grow the interactions with primary caregivers change to include for example, using the caregiver as a safe place from which to explore the environment. This includes exploring relationships with other people. Other family members gradually enter into infants' mental system and add to their private interpretation of the world. In optimal situations the primary caregiver remains as an important mediator and translator of experiences. 

Observations of healthy maternal infant/child interaction demonstrate the uniqueness of this relationship. The emotionality, expectations and interactional capacities are transferred to interactions with other significant human objects, especially with fathers. However, it is important to remember that interactions with mothers have exclusive meaning for the pair. 

It is important to note that there are some theorists that disown relational theories that emphasis the unique maternal infant relationship and contend that from early infancy, children benefit from interactions with many caregivers. These theories seem to disregard infantile perceptions and contributions to the relationship and also lack an understanding of women's emotional development. An extreme example of the concept of disregard for the unique maternal child relationship is exemplified by the communal raising, inclusive of cooperative sleeping, that used to be prominent in some Israeli kibbutz movements. This system of child raising no longer exists in Israeli kibbutzim. More recent information, particularly lay narrative, is showing the emotional devastation that many of those former children felt growing up with minimal exclusive mothering. 

An acknowledgement of the significance of exclusive mother child relationship helps us understand the loss that infants/children feel when they are separated from the primary caregiver prior to an expressed developmental readiness. This is further compounded when the maternal infant interactions include nursing. The nursing mother provides the infant with stimuli that can not be imitated in any other way.  
Families who decide that separation is an important part of their family plans, have the right to gain information that will enable them to create optimal compensating environments. They have the right to learn about the meaning of maternal infant interaction in nursing couples as well as the loss felt by infants in the absence of the significant nursing mother figure. Optimally they will learn that it is not enough to serve babies pumped breastmilk. Breastfeeding for infants is not about getting breastmilk. I believe that this is also true for many mothers as well. 

Many of you have written that you do not want to judge mothers who do not stay at home with their babies. Providing real information is not judging, it is a professional obligation. Giving parents information about the  the emotional aspects of nursing is just as important as providing them with information about the physiological aspects of nursing. 

Remember nursing is not only a physiological process but that it is also a relational behavior!    

Keren Epstein-Gilboa MEd BScN RN FACCE LCCE IBCLC PhD (Candidate) Human Development/Family Relationships

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