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Breastfeeding success or failure

It is amazing how the subject of breastfeeding, when discussed amongst women, becomes very personal, even when seemingly simple issues of management are being reviewed. This has been a “hot topic” on the ozmidwifery email list for the past week, and it began with an articles in one of the newspapers last weekend that put the “Pros and cons of breastfeeding” forward.

This article had been an exercise in damning breastfeeding with faint praise, mainly because it was being careful not to upset any women readers who might not have been successful in nursing their babies - the aim was clearly to try and not engender any guilt for apparent “failure”.

The debate has raged all week, not between breast and bottle feeders, but between breastfeeding mothers themselves, many of whom had experienced problems and who felt the level of care and advice they received from the professionals was unhelpful or unsupportive. Most of those joining the debate were midwives, but there were a number of women too, and some who complained of the “nipple nazis” or even “breast bitches”.

I should say that in Australia, where there is strong adherence to the International Code of Marketing of Breastmilk Substitutes, we have high rates of breastfeeding overall with about 50% of women still breastfeeding their babies at 6 months of age This figure might be even higher if more women were able to stay home and not return to work, but it is still a much higher rate than most other developed countries.

One aspect of the debate about how midwives support breastfeeding that hasn’t been mentioned is the innate sexuality of breastfeeding. One correspondent mentioned that women who were not successful with breastfeeding often felt similar guilt to women who had unexpected caesarean births. Pregnancy, birth and breastfeeding are all integral elements of a woman’s sexuality and it is no wonder than any messages a person receives (in any form) that casts doubt on an aspect of their sexuality or capacity for sexual expression, could be seen as threatening and likely to produce a range of emotions, including guilt.

Many years ago, when I first became interested in the whole birth scene, I got started by counselling women with breastfeeding problems. Mostly this was over the phone, but sometimes I visited them as well. It quickly became clear to me that the reason women were finding breastfeeding difficult was not because of their own shortcomings, but because in one way to another, the way the birth was handled had upset their hormonal system or created barriers to the successful initiation of lactation. Most of the labour management strategies in use have this potential capacity: drugs given to the mother can affect the baby; oxytocic drips can disturb the delicate hormonal balance in the new mother for many hours and cause jaundice on the new baby; Forceps or vacuum could give the baby a headache; the list goes on.

Soon after I began putting these factors together, I was lucky enough to meet Walter Whittlestone, a very eminent lactational physiologist from New Zealand whose work on oxytocin was world renowned. He stated clearly that lactation was the most reliable of all the body’s systems - more reliable than respiration, circulation or digestion, for example. This was important because the survival of the next generation depended on a regular and plentiful supply of food.

I believe that the reason women have difficulties with breastfeeding is because the health care system interferes with the hormones and natural behaviours that are necessary for success. Women should stop blaming themselves and turn their attention to finding ways of getting better care during labour and birth. It is not the women who have failed, it is the system that has failed them, and jeopardised the health of their babies through making breastfeeding difficult. All the attention on ensuring “correct latching” (almost an Olympic sport these days) has come about because babies are drugged at birth, their reflexes may be depressed and women are often in no state to interact in a spontaneous and nurturing way with their newborns. The medicalisation of birth has spawned the medicalisation of breastfeeding, with experts, special clinics, and endless advice that puts pressure on women to “get it right”. No wonder some women struggle and finally give up.

This sad state of affairs has provided a reason for a whole new layer of health professionals (lactation consultants) to get themselves established. If more effort was put into helping women make the link between birth interventions and later issues with breastfeeding, perhaps some would stop blaming themselves when their have milk supply problems and recognise that if they had taken fewer opiate drugs in labour, for example, either as pethidine or in the epidural mix, they may have avoided this kind of situation developing.

Years ago, I realised that the key to better breastfeeding lay in enabling women to have natural, undisturbed births. That’s why I turned my attention away from breastfeeding counselling and have put my energies into supporting ways of achieving better midwifery services that will benefit mothers and babies. I think tackling these links is an important key in increasing breastfeeding rates around the world.

Posted by andrea at May 22, 2005 06:45 PM