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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