Friday, June 19, 2009

Where do our ideas about breastfeeding come from?

What does a mother tend to hear if she smokes? Has food poisoning? Has a beer? Is taking anti-depressants or even anti-virals or antibiotics? "You should stop breastfeeding – just to be on the safe side."

Now see what the WHO says are contraindications (opens a PDF). Note how very, very short it is. (Could we print this out and hang it up in every medical office? It wouldn’t take much space.)

What is the underlying message when mothers hear the stop-to-be-safe line? That breastmilk is best – but it is also very easy to ruin in which case it is DANGEROUS! Formula, on the other hand, is basically as good as breastmilk, and always, always safe (Har.)

This message undermines breastfeeding. It gets into people’s heads and stays there. I did a focus group with med students about breastfeeding promotion and one aspiring pediatrician said, “Of course, lots of women can’t breastfeed, because they’re on medication.” The others all nodded and agreed. (This is one of the reasons I want to start a breastfeeding workshop for med students at my school, but I digress.)

This message works because we have internalized another message, that formula is normal and breastfeeding is “special” in that it confers “extra” benefits. If breastfeeding is normal, then instead of breastfeeding’s benefits (lower risk of allergy, diabetes, etc.) we would talk about formula’s risks (increased risk of allergy, diabetes, etc.) So when any risk, even minor, is introduced into breastfeeding (ooh, you had a glass of wine? Better pump and dump), it’s better to go with something that you know is totally safe. Right?

Where did THAT message come from? Why do we see breastmilk as so fundamentally untrustworthy? Jacqueline Wolf is a professor of the history of medicine and has done some fabulous research on the history of breastfeeding and artificial feeding in the U.S. Her article, “The Social and Medical Construction of Lactation Pathology” (Women & Health, 2000. 30:3,93-110) explores how and why we started constructing this idea of breastmilk as easily spoiled and dangerous:

Women’s accounts of their breastfeeding travails and their consequent need for galactagogues and human milk substitutes engaged early twentieth century pediatricians like no other medical crisis. Despite doctors’ universal support of breastfeeding--and their consistent condemnation of artificial feeding--they began to corroborate mothers’ frequent reports of too-little, or bad, breast, milk.

Note: She has also done research on why there was a growing epidemic of “bad” or insufficient milk starting in the 1880s, and concludes that it was due to the rising popularity of regimented feeding schedules (often feeding every 4 hours) which lead to low milk supply.

Physicians publicly advised women of the dangerous propensity of human milk to metamorphose within women’s bodies. When F. W. Reilly, the Chicago Assistant Commissioner of Health, urged mothers in 1895 to nurse their babies in order to keep them healthy, he coupled the decree with an equally stern caveat. Under certain conditions, Reilly warned, "even breast milk" caused babies severe digestive distress. If a mother is overheated, he explained, she should express and discard a teaspoon of milk before breastfeeding, implying that the milk nearest the surface of mothers’ bodies could easily sour--like cow’s milk left on a porch during the summer. …

Although the medical community continued to declare breastfeeding the optimum practice after a birth in principle, doctors now counseled mothers and each other that human milk was best only if a mother supplied her baby with, not just any breast milk, but an "average" breast milk (Churchill, 1896). "Below-average" or "too-rich" human milk, they contended, posed as great a peril to babies as breast milk substitutes. An editor of an infant-care magazine reminded mothers, "Remember that to-day the best artificial food is quite as safe as a poor quality of human milk" (Nursery Problems, October 1887).

So now, even when we understand the principles of milk production and how to ensure a healthy milk supply, we’re still left with the idea of breastmilk as a touchy, easily spoiled substance and mothers’ bodies as unreliable. (If you want to read more about this I highly recommend Jacqueline Wolf’s book, Don’t Kill Your Baby: Public Health and the Decline of Breastfeeding in the 19th and 20th Centuries. She also has a new book out about the history of obstetrical anesthesia, which I am really excited to read.)

We need to get a new mindset in – from “if there’s anything potentially wrong, stop breastfeeding” to “there’s very little so bad that it can outweigh all the good things breastfeeding provides”. Otherwise, we’ll keep getting women advised to stop breastfeeding because they have food poisoning, have had a beer, smoke, is taking anti-virals, or because the “baby is gaining weight too quickly” – all reasons I have heard personally from medical professionals or the mothers the advice was given to. And that's just not helping.

Oh, and when I did a google search for “reasons to stop breastfeeding”, what was the first ad to come up?

Stop Breastfeeding
Get a Free breastfeeding support
kit w/ important DHA supplement.


Elita said...

Really interesting stuff! Thanks for digging it up. There was also a dialogue on Lactnet recently on cultural beliefs surrounding breast milk and it seems many cultures have all these strange beliefs about how and when breast milk can go sour inside a woman's body, like if she is too cold or too hot during labor or skips even one feeding!

publichealthdoula said...

Isn't it fascinating? There are so many breastfeeding beliefs out there... "Colostrum is poison", "Milk goes sour", etc. It seems like a delicate balance to respect people's cultural background and not insult the advice of their family/community, but still try to bring new information into the discussion.