Breastfeeding is the biological norm. Breastmilk is uniquely suited for a human baby and discoveries are still being made about the way it interacts with an infant to give it optimal development. For thousands of years women gave birth and nursed their babies, supported by a close-knit group of family and friends. If difficulties arose they were surrounded by others who would help. What happened to change the fact of breastfeeding as a natural part of motherhood to something which often causes pressure, guilt and negativity?
It cannot be ignored that breastfeeding is the cause of a lot of anxiety among mothers and the subject of heated debates. Something clearly needs addressing when so many new mothers find breastfeeding difficult and end up feeling they have failed; when in actual fact it is usually they who have been failed by lack of the right support at the right time. Women who stop breastfeeding before they wanted to can be left with negative feelings and the pressure on women to breastfeed is often blamed.
Perhaps however the question should be posed from a different angle. What has happened in our society to make women feel that breastfeeding is a pressure and not something that they expect to do after giving birth?
Replacing breastmilk with formula
The decline in breastfeeding began with the advent of infant formula. When the first artificial milk substitutes were developed in the late 1800s they were never intended for large scale use. They were a useful way to use surplus milk from the dairy industry and were to be used in particular to feed orphans and foundlings who had no other form of nutrition. Wet nursing was on the decline due to fears that various diseases could be passed from wet nurse to baby and vice versa.
Formula manufacturers soon realised that there was a wider market for their product and started selling it to mothers as an improvement on breastmilk and the best way a modern mother could feed her baby, without any proof, of course, that this was the case. Women always want to do the best for their children and believed that formula was the new, improved way forward. Breastfeeding became “old-fashioned” and something that mainly poorer women might do. As more women formula fed and the sight of a breastfeeding woman diminished, the communal knowledge and confidence in breastfeeding was lost.
As women also began to move away from family, and had friends who bottlefed, they had no-one to turn to for support and it became an ongoing circle of decreasing confidence in something which had once been taken for granted. The use of the female body in advertising also added to the growing feeling that breastfeeding was something that was not publically acceptable. Breasts could be shown to advertise almost anything but using them to feed a baby caused protests.
The need for support
In the 1970s the breastfeeding rate in GB was down to 28% and this included babies who had been put to the breast even once. Yet many women still wanted to breastfeed and turned to lay organisations for the support they did not get elsewhere. Over the past few decades there has needed to be a concerted effort from dedicated health professionals, and volunteer breastfeeding counsellors to try to give women the information and support they did not get elsewhere.
Offering this much needed support is now regularly defined, often in very unpleasant ways, as pressure. Yet breastfeeding supporters are not creating this pressure. They did not create breastmilk and try to persuade women to use it to feed their babies. While some women know breastfeeding is not for them, and a small percentage have supply issues, when the majority of women give birth their bodies produce milk and are ready to breastfeed. A baby is born expecting to breastfeed and it is a woman’s natural instinct and her bodily functions which are at work to tell her to do so. Stopping before she intended to, rather than pressure to breastfeed, can sometimes lead to a woman to feel guilt, sadness and depression, possibly because of the hormonal changes in her body and because she misses the breastfeeding relationship.
Breastfeeding and post-natal depression
A study published August 2014 in the journal Maternal and Child Health, found that mothers who planned to breastfeed but who did not go on to do so were over twice as likely to become depressed as mothers who had not planned to, and who did not, breastfeed1. Women who breastfed their babies were around 50% less likely to develop post-natal depression than those who did not breastfeed . The benefit increased for each week of breastfeeding up to one month.
The study acknowledges that mothers who wanted to breastfeed and didn’t manage to need a great deal of understanding and support. It says there is currently hardly any skilled specialist help for these mothers and this is something health providers should be aware of so they can offer appropriate support.
In her book Depression and New Mothers, Kathleen Kendall-Tackett, PhD, IBCLC, reports that rates of depression are lower in breastfeeding mothers than their non-breastfeeding counterparts 2. She also notes that breastfeeding is protective of maternal mental health because it reduces the stress response. She explains how stress and fatigue can increase risk for depression, but lowering stress can be protective. This is where breastfeeding can make a difference.
Kendall-Tackett says that breastfeeding also protects babies from the harmful effects of maternal depression. One apparent reason for this finding is that by simply breastfeeding, mothers were more likely to touch, stroke, and make eye contact with their babies. Another possible explanation for the beneficial effect includes the release of feel-good hormones when milk is produced. This is one more good reason for encouraging mothers to continue to breastfeed even while depressed.
The Pressure of Formula
The question which perhaps needs to be asked is where in this discussion is the pressure put on women by formula companies? While advertising infant formula for under six months is prohibited, it is perfectly normal to see adverts for follow-on milk which give a very clear impression that a baby will be formula fed (once mother has “done her best” “is ready to move on” and if they do “they are doing great”). Follow-on milk was only manufactured by formula companies after the advertising ban for formula under six months was introduced. A statement by the World Health Organisation (WHO) states that follow-up formula is not necessary, and is unsuitable as a replacement for breastmilk after 6 months .
Where is the mention of all the subliminal pressures which indicate a baby will probably be bottlefed – the use of bottles as a symbol for changing rooms/feeding rooms/on washing machines for the delicate cycle, and so on. Bottles are seen on television, in adverts, in articles. They are included in children’s toys and used in books.
The discussion about pressure always seems to be one-sided. Often mothers tell breastfeeding organisations that in the hours after birth, tired and emotional, scared their babies were hungry, they bowed to pressure to give a bottle. This immediately undermines their confidence in their ability to breastfeed and already plants a seed that they won’t be able to do it. Busy health professionals may not have the time they want to spend with mothers, or to explain how it can take time for her to learn with her baby. Often women get conflicting information and end up worried and confused.
Once home well-meaning friends and relatives are often quick to suggest that the new mother gives formula or to suggest they look after the baby while the mother has a rest. It is not enough to give women information about the importance of breastfeeding if, once the baby arrives, there is not enough support in place to help them to do it.
It’s time to change this debate round
Perhaps it is time we asked just who is doing the pressurising and how women have become so undermined in their confidence to breastfeed that they accept they will probably end up formula feeding, even if so many are left wrongly feeling guilty. Formula has its place for women who have made a definite decision they do not want to breastfeed, and, as was originally intended, for the small percentage of babies who have no other way to feed. However it should no longer be held as the default position, something women will most likely need to turn to because they believe breastfeeding to be too hard.
What most women want is to achieve their own breastfeeding goals. They may want to breastfeed for a month, six months or much longer. Only by creating a society in which all women feel confident in their ability to breastfeed until they want to stop will we eliminate the negativity which seems to surround it for many mothers. It’s surely time to change this debate round and ask what we need to do for women to once again embrace breastfeeding as their and their babies’ natural right and to enjoy it as part of their mothering journey.
Written by Anna Burbidge
1. Borra, C., Iacovou, M. and Sevilla, A. “New Evidence on Breastfeeding and Postpartum Depression: The Importance of Understanding Women’s Intentions”. Maternal and Child Health Journal: 20 Aug 2014
2. Dennis and McQueen, 2009
Copyright LLLGB 2016