Wow, Pamela! What a post. The anthropologist in me was fascinated and the feminist appalled by the conditions you describe. You have made a spectacular case for supporting the rights of the baby. My favorite part and for me the most convincing part of your post, was the description of how things were handled when there was no formula. How the women rallied and babies thrived. I think that is the ideal toward which we are all striving. A time when the local Rite Aid has been stripped of formula. Not because there is a war, but because we have found a way for all babies to have  breast milk. Either their mother's or another mother's milk. We are not there yet and each society has come up with their own solutions. 

The part that upset me, was that breastfeeding (and I would bet childbearing) are seen as the duty of any given woman, to the point where if she fails in this duty she is abandoned and shunned. I have a client right now who is suffering from a fistula sustained at birth. She has managed to continue to breastfeed through this whole hideous process because she has support and determination. I shudder to think what would happen to this woman and her baby, in a society where childbearing and breastfeeding are considered her duty. She wants to have another baby in a couple of years and is lucky that she is neither shunned for her situation nor does she have to face having another vaginal birth.

My heart breaks for women all over the globe whose duty it is to have to clean the house, bear the children, breastfeed the children. Each one of those activities should be a choice. The feminist in me wants to fight against those attitudes. I understand that this is ethnocentric of me. In college, I studied cultural anthropology for a while, but decided I wasn't cut out to observe and accept. I have too big a mouth....I would want to change!

You mention determination. The educated women I work with in Brooklyn, who have brought me into their homes to help them breastfeed blow me away with their determination. They are generally women who have succeeded at their careers and are now determined to succeed at breastfeeding. They attack it with grit and gusto because the groundwork you speak of, education about the benefits of breastfeeding, has already been laid. They have attended classes, read books and surfed the web. Their heads are so full of breastfeeding rules and suggestions that they are spinning. They understand the imperative to breastfeed. That is why I am there. I wouldn't be in their home if they didn't already really really really want to succeed. But to put an overlay of duty on top of that determination is horrifying to me. It is every woman's duty to be the best mother that she can be, once she has made the decision to bear children. Period.

But how she accomplishes that duty is up to her. It is not my place to say to my surgical resident who has to wean at 6 weeks because the asshole leading her team won't give her a pumping break, that it is her duty to supply breast milk. It just simply isn't true. And until the Rite Aid shelves are cleared of formula and the milk banks are overflowing with breast milk, I will sit with that grieving woman and tell her what an amazing person she is for having spent 4 weeks with hideously cracked nipples perfecting breastfeeding and finally getting there. What an amazing person she is for having gone to medical school. What an amazing mom she is going to be, because she is crying that she has to leave her baby and go back to her career. We need to fight to change society to empower this woman to be able to have her career and breastfeed too. 

As for helping a woman who has postpartum depression wean, I believe that part of that process is a discussion of the hormones of breastfeeding and what might happen when she weans. Not just with prolactin, but also how beneficial oxytocin can be. We explore how she feels when the baby is actually breastfeeding versus how she feels when the baby is off the breast. That is part of the work of helping a mother make this decision. 

There are societal and emotional impediments to nursing a baby. The fascinating thing is that more and more women are overcoming those impediments because they personally have decided it is their duty to breastfeed their baby, based on what they know about the risks of formula feeding and the benefits of the normative process of breastfeeding. I have many clients who never perceive breastfeeding as lovely, it is done for the benefit of their child. They are generally motivated by a desire to do the right thing for their child, not by a fear of being shunned. That is not to say that societal pressures aren't important. Many of my moms would be more embarrassed to pull out a bottle of formula in a Park Slope playground than they would be to pull out a cigarette. This pressure is a good thing - until it is not. Until there is a point where that mother must use formula for some reason or another and is made to feel bad about her mothering - by me or anyone else in society.

Kathy Lilleskov RN IBCLC

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