Lighten up, it's just Fashion

There is a great mystery in the world of breastfeeding support. How can so many women fail? How can so many women have such problems with pain and supply? We know that this isn't normal, women in other cultures don't have the problems we do.

What do we do? We blame the women: "She should have called the lactation consultant sooner! She should have called more than one! She should have gone to LLL while she was still pregnant! She should have danced naked in counterclockwise circles while spreading fenugreek on her doorstep and rubbing oatmeal on her breasts!" We blame those that should have been supporting her, we blame bad advice given at the wrong moment, we blame lawsuit-phobic nursery staff that pushes the canned food at the merest sniff of an elevated bilirubin level, we blame the high rate of c-sections that makes high bilirubin that much more of a common occurance.

But, we never answer the central question: WHY IS BREASTFEEDING SO FUCKING HARD?? It shouldn't be. If evolution worked the way it's supposed to, feeding our young would not be something that involves some of our tenderest bits getting bloody and scabbed. It would something relatively surefire.

Clearly, it's not. And there's no predicting which women will have serious problems and which will sail through with a little discomfort.

My completely unsubstatiated theory is that because we don't expose our nipples to sun and air, they are more tender than they would have been in a culture that doesn't sexualize and hide the breast. The very act of covering our breasts and shaping them with bras as soon as they make their appearance in adolescence might cause the kind of subtle structural changes that would result in the problems that are common here and rare in other places; low milk supply, flat nipples, high sensitivity, plugged ducts, bleeding, scabbing, PAIN. 

So, there's nothing to be done, short of burning our bras and letting our breasts be seen* for what they truly are. And, uh, good luck with that. I can love my real-life working breasts until I'm blue in the face, it's not going to make a shred of difference to the readers of FHM, or to the industry that tells us what parts of our bodies can be deemed attractive.

As a breastfeeding educator, I have come to accept that there are unseen forces at work that make our success rates lower than they should be. I do what I can to help women mother the way they want to, but sometimes there's nothing I can do.

ps- this was the gist of the Lost Post, but the Lost Post was longer, more linky, and all around better.

*Edited to add a very relevent link to Shape of a Mother.

Comments

[Elizabeth]

That is a really interesting theory. It is my opinion that subtle hormonal imbalances from the diets we eat (and were fed as children) and the toxins in our environment probably contribute to the preponderance of breastfeeding problems, too. But I think so much of it is that breastfeeding has been a truly invisible activity in our culture. My mom BF me and my sister and I don't remember ever seeing her nursing my sister (I was weaned at 10 months so obviously I don't remember being BF). I DO remember bottles, though. My own and my sister's! I think the first time I saw someone breastfeeding was in my mid-20's (it was my cousin). And I was far too embarrassed to sit near her and "take notes", even though I knew that I would probably BF my own kids someday. It just seemed strange and awkward, and everything around BF seems strange and awkward to most people in our culture. We're not comfortable with our bodies in the first place, and then to have to use our bodies to nourish someone else, while trying not to "reveal" a part of the body that has been fetishized, which is simultaneously ubiquitous and taboo? Ah, it's a lot that we take on when we BF! Thanks for this post.

[Kateri]

There's a whole slew of things I didn't get inot like the environmental toxins and artificial diet and all that other stuff that you mentioned. Thanks for adding that. It's an improtant note.

[fuzzit]

I am pretty shy when it comes to my body except maybe around my husband. How can I desensitize myself to it? My cousin is bf'ing her daughter but I have never seen her do it around anyone. I have a feeling I will tend to do this too. In Inna May's book about breastfeeding and bonding she says to expose your breasts to the sun or a sun lamp to toughen them up...
where can you get one of these for not so much money?

[abogada]

I've wondered "why" myself. You have an interesting theory. All I know is that it was very hard for me, and it hurt like h*ll in the beginning, even though I was told in my breast feeding class that it shouldn't hurt if I was doing it correctly. We did use an L.C., and I still take Reglan to this day. My daughter was diagnosed with failure to thrive because I wasn't producing enough milk to satisfy her, but with the support of her pediatrician, the L.C., my ob/gyn, and most importantly, my husband, we managed to muddle through. And now my daughter is 22 months old and still going strong.

[Bridget]

does it ever piss me off when they say "it won't hurt if you are doing it right."

i'm not sure it should necessarily be easy, i mean women have used wet nurses for hundreds of years.

I'm not saying breastfeeding isn't a wonderful amazing experience that is beneficial for mother and child, but it takes some practice and it is hard at first, and i'm thinking maybe always has been. I don't think it's un-natural to take some getting used to. It's just something you need a helping hand, like say your mother, sister, aunt, etc.

I'm not trying to blame any of the above mentioned womena nd relations for not supporting a nursing mom. Just saying, it's a challenge, but it's rewarding, and stick with it. You can do it.

Finally, posting a picture of me breastfeeding, as I do think seeing it as normal is a big step in teh right direction.

[lena]

Excellent observations. I also think that we malnourish ourselves postpartum to lose the baby weight here in this image obsessed country.

[Margot]

Actually, I kind of suspect that it wouldn't necessarily be easier in a state of nature.

My feeling is that nature doesn't much care about whether breastfeeding is difficult or hurts the mother. After all, there are plenty of species where the infant basically eats the mother. Nature just cares about reproduction and keeping enough babies alive to keep the species going.

Some people find breastfeeding easy, some find it hard and everything in between, just the way there is a range of other physical abilities - some of us can jog easily and some of us can't at all!

Margot

[Tessy]

I have a question. My son is 3.5 months old. (He's my third......all breastfed, but only until 6 months.) He has increased the amount he eats while I'm at work (I work fulltime) to about 5 ounces at a time, but when I pump at work (I use a double electric) I only get about 3.5 to 4 ounces. I have no problems when nursing him myself, but my frozen supply is about gone making up the difference while I'm at work. I tried fenugreek and strangley enough I got LESS while on it. Any suggestions? Please email me if you've got any advice.

Thanks!

[Away2me]

I totally agree with your theory and I hope you won't mind if I link this post to my blog. I've been preaching what you said about our boobs not being exposed forever. I have wondered if bras have anything to do with an increase in breast cancer?

I wish I could have breast fed my son, but induction is difficult and while I induced twice before him, this time around I produced even less and he had a hard time staying latched on me. The LC said I had, "difficult breasts". I tried for three weeks and I know he got some good stuff from me inthat time. Wish it could have been more.

[Kateri]

On that site I linked to above www.007b.com they have an article about how bras may cause breast cancer because they block lymph from draining and backing up toxins in the tissue or something. Interesting, but I wonder how extremist that site is.

[Elizabeth2]

I think in the 'state of nature' a heck of a lot more babies just died. A lot. Something like 1 in 10 babies in Afghanistan doesn't make it to age 1, and I'll bet they all breastfeed there, and our ancestors had it even worse than in Afghanistan today...

[Jo]

GREAT post, Kateri. Fashion and toxins, oh yeah.

Elizabeth2, lots of babies die in Afghanistan, but not because breastfeeding fails -- chronic malnutrition (I mean prenatally), violence, depleted uranium, and widespread disease aren't exactly ideal conditions. In general, except during times of famine, our ancestors did *not* have it worse than Afghanistan. No way.

I can't remember the source, but according to studies in great apes, the ability to breastfeed is lost after *ONE GENERATION* gets taken out of the loop. Nobody's sure exactly what the mechanism is, but apes in captivity were at a total loss of how to nurse their babies. They had to be shown by human mothers and infants, and then they were able to figure it out!

So if you think about it, we are in general at least one, and sometimes two or three, generations removed from widespread breastfeeding in our culture. Whatever the mechanism (knowledge transfer, observation, sheer normalcy), is it any surprise that breastfeeding is so difficult in our culture?

[Elizabeth2]

Here's how I know our ancestors had it worse than they have it in Afghanistan today: the population of Afghanistan is growing. And for millenia, the human population worldwide barely grew at all. (see picture at http://www.h-net.org/~demog/). There was no such thing as contraception, and yet on average, every adult woman had only 2 children survive to have children of their own.

Most of the increase in surviving-to-have-children-of-our-own has been a change in infant mortality, though maternal mortality is also a very big deal (death in childbirth is the leading cause of death for adult women in Afghanistan).

But I'm talking infant mortality, and the subject here is breastfeeding....so I'll quit with the Afghanistan tanget and better explain where I'm getting the connection:

Kateri said "If evolution worked the way it's supposed to, feeding our young would not be something that involves some of our tenderest bits getting bloody and scabbed. It would something relatively surefire." And I think she's making it sound way too simple. Just because evolution happens, doesn't mean that everything is pain free. Or that every baby is going to survive. Or even every mother.

My great-great-grandmother lived in a century before there was such a thing as formula, and she died of mastitis. Somehow my great-grandmother survived--I'm guessing a wet nurse.

Childbirth hurts, but we still have children. Nursing hurts, more for some mothers and less for others (and maybe not at all for some lucky mothers), but our ancestors fed their babies anyway, or we wouldn't be here.

I think some of the pain of nursing may be a matter of perception, since we have so many fewer other pains compared to our ancestors. I think of how much my teeth hurt before I had a root canal done, and I can't imagine going through life without benefit of dentistry. But our ancestors did. I remember seeing an interview with the leader of an indigenous tribe in the Amazon basin which had just decided to settle down instead of hunting and gathering, and he said something to the effect of "you people have no idea how much our feet used to hurt when we spent our whole lives walking". If our ancestors had feet that hurt, and teeth that hurt, and all sorts of other things too...nursing pain was probably more of an afterthought.

I'm not saying that 'modern medicine is the answer to everything that ever bothered humanity'--but I am saying that the world has changed so much these past few hundred years that it's nearly impossibly to wrap our minds around how big the changes are, and how bad the bad old days really were (not that everything about them was bad).

Losing a lot of breastfeeding knowledge--obviously a bad thing. But assuming that every baby born to a healthy mother is going to get enough to eat and is going to survive long enough to learn how to crawl--that's a HUGE change, and a wonderful change, and a change that's so big and so fundamental that we forget such a change ever happened at all.

[Jo]

Elizabeth, it's interesting that Afghanistan's population is indeed increasing -- but I have to disagree that that's an accurate indicator of overall population health. From Malthus to Charles Mann, those who study population dynamics note that an expanding population isn't necessarily a good thing, as it often eats up all resources and results in catastrophe. A stable, sustainable population is usually the more healthy one.

While it's true that, in the past and all too often in the present, people die of treatable causes, that doesn't tell us much about breastfeeding either historically or cross-culturally. It is relevant, however, to note that most infants died (and, worldwide, still die) of infectious disease, particularly waterborne infectious disease.

In general, according to Malthus, mortality (and esp. infant mortality) correlates to living standards and environment.

Here's an interesting article about how in the Middle Ages in Europe, "children are at high risk to fall ill or even die especially in times of weaning. Trace element analysis of the skeletal remains of small infants excavated in Schleswig (northern Germany, 11th/12th century AD) led to the estimation of weaning age as well as to the reconstruction of a stepwise substitution of mothers' milk by other food items." See http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=2665340&dopt=Abstract.

Breastmilk actually provides somewhat of a protective effect against infant mortality.

But that wasn't what you were asking, was it? We were talking about conditions in Afghanistan vs. conditions for humanity, in general, historically. Which are pretty much impossible to compare, since "history" is so enormous. There have been periods where certain groups of people have had it worse than present-day Afghanistan; there are periods when people have had it better. But I think to have this discussion under the umbrella of a historical view of breastfeeding is nigh-on impossible, and somewhat disingenous.

[Deirdre]

I think you've hit some good points in this post. However, I do think that culture also plays a big role. I've talked to so many new mothers who suffer when breastfeeding, but upon further inquiry their babies have had numerous bottles or suck on a pacifier all day. That's "normal" in our culture, but all that non-breast sucking changes many babies' breast sucking. They have been trained away from what would hurt the mother less. (For all who read this: I'm not saying that babies should never have a bottle or a pacifier, but I am saying that there is a cost and that it is better to wait until breastfeeding is smoothly established.)

Whoever mentioned above about gorillas losing knowledge of breastfeeding after one "lost" generation hit a nail on the head. As I was breastfeeding in front of some chimpanzees yesterday I told my family about a gorilla who was trained to feed her baby when the keepers brought in lactating mothers to feed their infants in front of the gorilla's cage.

...And that gorilla story is why I love LLL so much. It provides a missing link for many women.

...It's also why I'll happily plop down in public to feed my baby even though I am not totally comfortable BFing in public.

[Amy]

This is a great post! I honestly haven't thought about covering/hiding our breasts and wearing bras affecting breastfeeding. But we are so inundated with information all the time, aren't we? Do "this" (wear bras for instance) to keep the structure of our breasts intact; less chance of breast cancer (is what I've been told). Didn't every magazine I read when I was pregnant remind me to constantly wear a bra to support my pregnant and then breastfeeding breasts??! I breastfed both of my children, for an excruciating ONE WEEK (each). I was in horrible pain. They latched well, they ate well, I had an enormous supply, they thrived, I cried in agony. And I got that bullcrap "It shouldn't hurt if you're doing it right!", but then was told I WAS doing it right! WTF? Am I a bad person now because I couldn't deal with the pain? Some days I wonder. I had my son without drugs, could birth him through the pain, why couldn't I breastfeed?? Then I take a deep breath and let it go.

I like the comment about losing breastfeeding after one generation. As much information as we are now getting in this day and age about breastfeeding, breast is best, etc. I had NO support from my mother and mother-in-law. My mother breastfed me, and I didn't even know! The advice? "Oh I just did it, it was no big deal". My mother-in-law? "You probably can't even do it anyways, don't worry about it at all. I didn't breastfeed, they will put a big wrap around your chest so your milk doesn't come in." There's that generation lost I think.

[Sara]

The gorilla story has always impressed me with just how non-instinctive nursing is, as a mothering behavior.

As I tried to explain to someone once -- the images and expectations of mothering in this country are set up around bottlefeeding. What do they decorate shower invites with? Bottles. What one clipart image says "baby?" A bottle.

Even the baby books that are "pro breastfeeding" mostly have a separate chapter on nursing that is an addition from earlier editions that ignored it. All the nursing info is segregated into this one area, and so there's no metnion of it in places where it logically fits, like "why is my kid's poop green?" or "what to do about introducing solids." This also means that the rest of the books usually still retain their bottlecentric language ("At four months, most babies will drop from a 3-hour to 4-hour schedule," or "Babies generally will eat 2 oz for every X pounds of body weight," or "You'll be dropping the 4am feed about now." It makes the whole process feel like it is something that is unexpected, unusual, not part of the tapestry of parenting....

[Am]

Elizabeth2, interesting that you bring up Afghanistan...according to the book Milk, Money, and Madness, Afghanistan is one of the countries where it's common for postpartum women to express and dump colostrum and feed TEA (!) to a newborn until mature milk appears. Obviously there's a lot going on in Afghanistan but this makes me go hmmm...

Interesting post, Kateri, I wish it wasn't so hard for many women.

[ozma]

Interesting. I remember after much trauma I successfully breastfed. They were doing some kind of survey so they called me after a couple of months to see if I was still at it. "What helped you?" they (lactation consultant and midwives) wanted to know. I told them the truth which was: "I stopped listening to anything the LCs or midwives told me and just did what I thought was right."

The LCs would come in and tell me how I was 'doing it wrong.' After a week I was a total basket case. Finally, I just decided to ignore everything they said and happily breastfed my daughter for 2 years.

I found breastfeeding--mostly due to all this intervention--more traumatic than labor or my c-section.

[meadowmouse]

In my experience, it was the baby, not the boobs that had the problem. I had 5 different professionals try to help us, to no avail. In the end, I had to find a way to feed him and guilted myself incessantly about it. I horrified myself by wondering how my child would have survived in previous cultures.

[Tina]

Having breastfed 2 babies (very painful 1st week with my first, can't remember with my second and really unhelpful lactation consultants) I think that the main difference in breastfeeding "success" between modern and ancient cultures is motivation. We have a choice whether we breastfeed or not, since we have access to a nutritionally adequate substitute. Without this option mothers would simply watch their babies do less well, grow slower and be sicker quicker. So it would be, breastfeed (more or less painfully depending on individual experience) or feed your baby a not very good substitute. For mums who find breastfeeding torture, there is no reason any more why they should carry on. For me with a bit of persistence the pain went away and it was a great experience for my daughters and myself.
And, yes, culture does matter, poor body image, body anxiety, shame about breastfeeding in public, oversexualising the breast definitely creates a lot of negative weight for women who lack breastfeeding confidence. My whole (African) family has breastfed for generations with little discussion of breastfeeding as an "issue". Interestingly most of my cousins have used the odd bottle of formala or breastmilk with in later months with no change to the sucking style of their babies.