Thoughts about Breastfeeding in a Modern Society

by Marilyn Hogan, IBCLC

Many people these days are breastfeeding their newborns. But did you know that even though more women are starting off breastfeeding, by a few months a lot of them have switched to formula and bottle-feeding? There are many reasons for this, and these are some of the issues that we can explore in this website. We will also look at ways that you can continue breastfeeding even in the face of challenges.

Our society still has a long way to go in terms of supporting moms who want to continue breastfeeding, and we need to remember that most breastfeeding challenges have breastfeeding solutions. In the past, during the middle of this century, when a mom encountered problems, she was usually advised by well-meaning caregivers and friends to switch to formula without even trying to figure out how to make the breastfeeding work.

Very little time was spent teaching doctors about breastfeeding in medical schools. Meanwhile, the formula industry was very clever at marketing their products and making sure that doctors and hospital workers knew all about their formulas. The industry people encouraged those doctors to recommend their products to any mother who was encountering any kind of breastfeeding challenge.

Furthermore, in so-called educational material directed to the public, women were encouraged by these companies to regard infant feeding as a personal choice that should be made in private with her doctor. This discouraged women from getting breastfeeding support and information from other experienced breastfeeding mothers, and encouraged them to assign complete control to their doctors for many of their decisions.

So women who decided they should formula-feed often did so thinking they were making a true choice. But choice is not really choice unless it is a fully-informed choice.

The breastfeeding-substitute industry has no motive to make it easy for women to realize that there are ways to increase milk production, to prevent or stop sore nipples, and to feel okay about breastfeeding in public. After all, the formula industry’s biggest competitors were not other formula, artificial nipple, and bottle companies, but breastmilk and breastfeeding!

In the middle of the twentieth century, there were tons of ads on tv that sent a constant message that formula was the normal, desirable way to feed a baby, (kind of like ads that used to say certain cigarettes were “healthier”).

The question that was put into women’s minds about breastfeeding was not even whether or not to breastfeed, but rather, which brand of bottle or formula to buy. One bottle manufacturer even claimed that theirs was “most like mother herself.” (Totally untrue — NO bottle is very much like breastfeeding at all.)

Nobody who stood to profit from sales of any breastfeeding substitutes warned of the risks of not breastfeeding. The sooner a women could be encouraged to switch to formula (or to use bottles and pacifiers at least), the greater the bottom line for them. There is an international code that prohibits this unethical industry behaviour, called the International Code of Marketing of Breastmilk Substitutes — also known as the WHO Code. Canada was a signatory to it in 1981.

Nowadays, the marketing is a lot more subtle, with formula-industry “baby clubs” popping up (often with the chance to sign up as “members” at their websites) that are just industry marketing tools for their products: they give free samples, discount formula coupons, and generally make breastfeeding appear to be unimportant, uncomfortable, inconvenient, inadequate or whatever else they can think of to undermine a woman’s confidence that she can fully breastfeed until her baby weans naturally.

These marketing activities are prohibited by the Code but they take place anyway. In Canada, the Code has not been made law, and industry is not sanctioned adequately to comply with the Code.

Now, in addition to mother peer support resources, there is another way to counter the industry tactics: fortunately there is a growing number of well-trained health workers and informed individuals who know that most healthy mothers of healthy newborns have the ability to make plenty of milk, usually enough to at least feed twins. Moms who make more milk than their babes can use, are encouraged to consider donating to the milk bank at Women’s and Children’s Hospital in Vancouver, BC.

With the growing body of breastfeeding research and literature, health workers are now realizing that it is possible to breastfeed in many instances where previously it was believed that breastfeeding would be “too challenging” or “not worth the trouble”. We know much more than that now, and the future is exciting indeed!

Women can breastfeed babies born sooner than expected, babies with cleft lip or palate, adoptive babies, babies with Down syndrome, and those born in many other circumstances where previously it was believed that breastfeeding was not an option. With good help, and sometimes medication too, mothers can even return to breastfeeding after they have stopped (this is called re-lactation).

Moms can breastfeed after breast surgery, even if supplementation is necessary — and there are even devices that allow the delivery of the supplementation during breastfeeding!

Research is now revealing more and more of the extraordinary properties of breastmilk. It is actually a living substance that changes daily and even throughout a feeding to meet your baby’s changing needs, and provides wonderful immunological protection whenever you or your baby encounter a virus (although if you are HIV positive, check with your doctor or local health department about current standards in relation to the advisability of breastfeeding — but there is a lot of good research on this lately that is quite reassuring).

Mothers can even breastfeed when taking most prescription drugs, including methadone, depending on the dose. Dr. Thomas Hale is the world authority on breastfeeding and drugs.

The immunological protection to the child offered by breastfeeding might provide life-long immunological strength and other safeguards in later life. Your baby also receives hormones through your milk, and the most bio-available forms of iron and other substances, such as essential fatty acids necessary for brain and eye development.

Most women need others to support their breastfeeding, the same way we needed the support of other mothers in previous generations for many aspects of birthing and parenting. To breastfeed or not is not a decision that should be made in isolation, with only a single caregiver, who may or may not be interested in breastfeeding — although this is certainly the message that the formula industry wants women to think. But the truth is that the solid support of one close friend or relative can make a big difference in a woman’s decision to continue breastfeeding in the face of obstacles.

Remember that many of our own mothers and grandmothers did not even breastfeed at all, or only a few months, when formula was marketed and promoted as being at least as good as breastmilk, or even better! So it is important to find someone who really believes in breastfeeding to support you emotionally, if you can. This person can even be someone who didn’t breastfeed much, as long as she is genuinely supportive.

There are mother-to-mother support groups all around the world, and various breastfeeding support groups at women’s centres, health units, and so on. Many women find these to be a tremendous source of information and encouragement. The women at La Leche League are very knowledgeable. There are online support networks now too, although I would be very wary of information from any website that features artificial feeding products. Better to go to kellymom.org or La Leche League or maybe even a Facebook group.

But not everyone wants to attend group meetings or go online. So a neighbour, a relative, the baby’s father, or a friend can be a big source of support. It depends on an individual’s preference. But most women who have a positive breastfeeding experience report having at least one person who wholeheartedly supports their breastfeeding.

That support can be particularly helpful whenever a mom is feeling vulnerable, such as when she might be experiencing some challenges or when people start to pressure her to wean when they think the toddler is starting to become too old to breastfeed. It is interesting to note that people will sometimes try to get a mother of a three-year-old to wean, but they think nothing of a child that age with a bottle or pacifier or sucking their thumb or any other “self-calming” type of behaviour.

As a rule of thumb, by the way, it always makes sense to judge the artificial against the natural, and not the other way around. Breastfeeding is the normal way to feed and calm a child, regardless of how natural any given culture is.

Although the support of a close personal contact person is pretty much essential, this is not to say that health workers do not count. On the contrary, mothers need knowledgeable and supportive health workers too. For factual information, it is important to get up-to-date information from very informed sources. This is now available from International Board Certified Lactation Consultants, breastfeeding counsellors, and public health nurses.

Fortunately, doctors, nurses, midwives, and lactation consultants are learning more all the time about the physiology of breastfeeding and about how to support women to prevent and overcome the various challenges and concerns that arise.

Professional support can be especially helpful if breastfeeding is not going easily. Some of the main challenges that women can encounter are:

— inadequate milk production (or perceived inadequate production. Sometimes moms who think they don’t have enough milk actually have too much! and the baby is just not getting the milk that is there. Milk quantity concerns often go hand in hand with baby not latching on well — or with timed feedings, switching sides too soon, and other causes.)

— nipple soreness

— breast pain

— baby fussy after feedings or falling asleep at the breast

— thrush

— overactive milk ejection reflex or forceful or intermittent milk flow

— baby not gaining weight well

— baby nursing “too much”, “not enough”

— how to continue breastfeeding when returning to work, and so on.

Many of these situations, as distressing as they can seem at the time, actually have easy solutions, and often the problem can be remedied quite quickly with ACCURATE PROFESSIONAL HELP. If in doubt about whether your breastfeeding is going well, seek qualified professional help from someone who has training in helping moms solve their breastfeeding problems.

We as a modern society still need to develop creative ways to give mothers a chance to easily continue breastfeeding in all circumstances, including if and when they go back to work. Many moms who breastfeed when they return to work find it easier to breastfeed than bothering with preparing formula, not to mention the cost savings, and perhaps most important, they treasure the continued close connection that breastfeeding provides.

They find that breastfeeding, especially, helps to make up for the separation, as many mothers hate to be away from their babies as much as their babies don’t want mom to be away.

Women need to be supported to find ways to remain with their babies as much as they would like to be. We have come a long way in terms of defining women’s liberation: we no longer need to think of staying home and spending time with our children as old-fashioned, anti-feminist and outdated. Child-rearing and full-time mothering are legitimate occupations that women should always be proud of.

Sometimes we can’t have it all though, and we do have to live without as much material comfort if only one parent is working. But our babies don’t care! Do we really need that new music equipment or fancy couch? Could we work online instead of leaving the baby? Be creative about living more simply, minimizing the need to be separated from your baby, and finding ways of lowering expenses and living on less. Your time with your baby is precious and each child is little for such a short time. It’s wonderful if you can treasure that time together and have quantity as well as quality time with your kids.

Mothers deserve the truth. Women are now seeing the advantages of breastfeeding not just for the health and well-being of their babies, but also for themselves, when they are provided with the information on the advantages of breastfeeding and the disadvantages of not breastfeeding.

Research is clearly showing the many benefits to women themselves when they breastfeed, including a significantly reduced risk of getting breast and ovarian cancer.

So women can really appreciate the many good reasons to start breastfeeding, and to continue breastfeeding optimally: exclusive breastfeeding during the first six months of life, and continued breastfeeding, with safe and appropriate complementary foods up to the age of two years and beyond, as recommended by the World Health Organization.

Happy breastfeeding!

Marilyn Hogan, IBCLC