8/23/09  
Susan Burger said:
<<Mothers should be assisted to start honing their observation skills (which
are usually better than they or anyone else thinks they are) and to use
these skills to develop a relationship in which they and their babies
respond appropriately to each other and INTERACT.>>

BINGO! I think that Susan has voiced a major point that we should be making
about breastfeeding—and indeed about infant and young child feeding of any
kind. It is INTERACTIVE. The communication goes in two directions. Surely
feeding is one of the richest relationships that a baby has with its
caregivers, particularly a mammal baby with its mother.

I’ve recently been thinking about infant and young child feeding as a
transitional stage between placental nutrition and eating from the family
table. (It’s a very long transition. Remember that Niles Newton said “…it
usually takes about fifteen years to develop adult table manners.”) If a
breastfeeding mom and baby follow WHO’s recommended “bf for 2 years and
beyond” pattern, then the baby goes from tasting special complementary foods
starting around six months to eating family foods as a toddler that are
modified by mashing, cutting, and picking the “best bits” from the family
pot. Meanwhile the mom’s milk provides at first the major part of the diet
(at 6 months), then an important supplement (at 18 months), then a snack and
pick-me-up that fills in the gaps in the young child’s day (at 3+ years).
That’s obviously a transition process. 

So nutritionally, that’s where mom’s milk fits in, but behaviorally,
suckling is only one of many options that a mom can choose at any time of
the day or night when her baby signals a need. We all know that you can
offer a breast for many reasons besides the observation that your baby is
thirsty or hungry…and you can do other things besides give the breast even
if you know that that’s what the baby really wants. So a mom is responding
to her baby’s signals in an interactive way, and the baby provides feedback
by accepting what she offers or fussing for something different.

The studies that Jane Heinig and others have done with Northern California
WIC moms showed us that mothers add new foods when they think their babies
“aren’t satisfied.” Mothers say that the cue to start supplementary formula
or cereal or additional baby foods comes from the baby—or maybe we would say
that it’s because of the mothers’ perception that the baby wants more than
the current diet offers. 

How much of this is a behavioral problem, though? Would the mothers feel
more confident about giving the breast (instead of starting a new food) if
they considered the breast as a multi-purpose mothering tool…yes, as a
pacifier, a sleep-inducer, a calming interlude, a “pause that refreshes”
much better than Coke, a “gob-stuffer”…as well as food and drink?

I’m pondering, too, about Julie Smith and Mark Ellwood’s time-use survey of
Australian mothers. Mothers recorded how they spent their time through the
whole 24-hour day for about a week, using a hand-held electronic push-button
recorder, at 3, 6, and 9 months. The findings are reported as averages per
week, which is a little hard to get my head around, since activities change
as babies grow and develop over nine months, but this method of reporting
makes it easy to compare the data. 

Activities that we might class as “breastfeeding” were recorded as either a)
breastfeeding/feeding expressed milk or b) carrying/holding/soothing baby
(which could include breastfeeding for comfort). They also described this as
“emotional care.” Over the nine months, the moms averaged 35 episodes of
each per week, or five “feedings” a day and five “carry/hold/soothings” a
day. They also bottle fed formula an average of 3 times a week; this was an
average for the whole group and probably reflects the small number who had
weaned by six months and the larger number who had weaned by nine months.

Moms spent an average of 16 hours per week breastfeeding at three months,
down to 8 hours per week at nine months. They also spent 10.5 hours per week
doing “carry/hold/soothe” at 3 months, down to 5.8 hours at nine months. So
this study found that this group of breastfed babies (who were breastfeeding
more than the national average—91% were still getting some breastfeeding at
six months, compared to 49-57% in some other Australian surveys)—were also
getting a lot of “non-feeding” body contact, which included some time at the
breast. The average length of a feeding was 18 minutes, and the average
length of a carry/hold/soothe episode was 13 minutes, about 75% as long.

I guess my point here is that these moms were giving their babies ¾ as much
time doing body contact and soothing at the breast as they were giving them
“feeding” at the breast. AND their  breastfeeding rate was way better than a
typical groups of U.S. moms. Are these two facts related?

Still pondering,
Chris


Chris Mulford, BSN, IBCLC
Project Coordinator, the PA-BC Business Case for Breastfeeding
Co-coordinator, Women & Work Task Force, World Alliance for Breastfeeding
Action

 “When she gives birth, every woman has the potential resource of breastmilk
for two years or more. This ample food resource is perfectly targeted,
already distributed to households with the need, and should be controlled by
the mother and baby.” --Helen Armstrong (1995) 
Breastfeeding as the foundation of care. Food and Nutrition Bulletin, United
Nations Univ Press, 16:4, 299-312.



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