Hello everyone!  This is my first posting to Lactnet.  I am a mother of
three who went back to school after my youngest was 8 years old and became
an OB nurse.  I have worked in L&D, postpartum, newborn nursery, and
prenatal clinic in a city hospital, and I am now working for a free
standing birth center.

I read with interest the posting concerning "Breastfeeding in the Hispanic
Culture."  I have not worked with many hispanic moms, but I have repeatedly
encountered the problem of women who want to "do both" - breast and bottle
feed.  In my practice as I prenatal care coordinator in south Philadelphia,
I have found that the problem does not appear to be restricted to one
ethnic group.  The only thing that my clients have in common is the fact
that they qualify for medical assistance.  I work with an ethnically
diverse population which includes significant numbers of Italian-Americans,
African-Americans, Southeast Asians, and Arabic women, and MOST of my
clients who choose to breastfeed (DEFINITELY the minority) express the
intent to supplement with formula, even after education about the risks
involved.  When asked why, many cite the ability of others to feed the baby
as an important consideration.  Particularly in the area's Italian-American
community , grandmothers seem to think that they aren't doing anything for
the baby unless they're feeding her/him! There is very little family
support for breastfeeding as a result.  Other women express the need not to
feel "tied down" to the baby or the need to return to work as soon as
possible.  The fear of "spoiling" the baby is usually mentioned.  I'm not
sure that these are the real reasons, however.  When I get right down to it
with them, the general consensus is that it's "gross."  They are simply not
comfortable with something so organic and animal.  This is a common problem
in our culture, but I feel that our low income, inner city women are
particularly susceptible.

In the population that I work with, I feel that the choice to breastfeed at
all seems to be a concession to the opinions of the "experts."    Most of
the women who do choose it are doing so not because they really want to,
but because they have heard that they should.  They seem relieved when they
fail. There is little support for breastfeeding in the community,
regardless of the ethnic subculture.  Very few have been exposed to actual
breastfeeding women. There is tremendous distrust of nature and an aversion
to natural body functions.  Few of our women even consider the option of
unmedicated childbirth, stating that they want their epidurals as soon as
they walk through the door.  Sexuality and modesty are definite concerns.
And then there's the squeemishness factor.   The thought of milky liquid
leaking from their breasts is enough to gag most of them!

Many of the nurses in the hospitals are products of the same community and
express the same attitudes.  They know the advantages, but most have not
breastfed their own children.  They become defensive about their own
mothering - nothing angers a mother more than the insinuation that she has
not done the best she could have done for her child!  As a result, they
tend to ignore or at least neglect to promote the medically documented
advantages of breastfeeding.  Their children "turned out just fine" on
formula, and so they simply refuse to believe that there could be a better
way.  They are incapable of teaching techniques and offering breastfeeding
support.  Added to this is the fact that hospitals are cutting staff in
order to reduce costs, and the nurses who do encourage breastfeeding simply
do not have time for teaching.  It's easier and faster to offer a bottle.

The mothers with whom I work certainly want the best for their babies; yet
they seem relieved when breastfeeding fails.  As I said before, I work with
mothers who qualify for medical assistance.  Mothers in the hospital with
private insurance who choose to breastfeed (still in the minority) seem to
be more confident in their decision and to be more likely to request that
bottles be withheld.  I know that prenatal education is not the issue,
because I'm doing a lot of the education.   I wonder if the inability (or
unwillingness) to transcend the general cultural bias (which promotes
breasts as sexual and body functions as disgusting) has to do with
powerlessness.  Self-image in my clients is often tied to body image, since
it is one of the few factors in their lives over which they have some
control.  This is true of many women in our culture, but of low income
women in particular.  They NEED to conform to community standards of body
image in order to feel validated, since they have difficulty achieving that
in other ways.  They are more susceptible to the pressure placed on us by
commercial interests - that attractive, interesting women smell like soaps
and perfumes, have no body hair, and have absolutely no body secretions.
They certainly don't breastfeed.

I recently took a job as a staff RN at a free standing birth center.  The
population is very different.  The clients consist primarily of confident,
financially secure women with upscale careers.  Although the mix is
somewhat different, there is ethnic diversity.  Upon talking to them, I
notice that most of them say they have not been exposed to breastfeeding
with any more frequency than their counterparts in south Philadelphia.
They have all chosen an alternative way of giving birth, and they ALL
breastfeed - exclusively.

All of this evidence is strictly experiencial.  Has anyone had similar or
conflicting experience?

Bonnie Reese, RN