Sophie Soklaridis is an Independent Scientist and the Interim Director of Research in Education at The Centre for Addiction and Mental Health (CAMH) in Toronto, Canada
Almost 23 years ago, I wrote a Master’s thesis that emerged from my experience with breastfeeding my son. After writing the cathartic 260-page thesis, I thought I was done with thinking about breastfeeding. Then I read about a woman with postpartum depression who died by suicide, with one of the main explanations she wrote in a note being that she was unable to exclusively breastfeed her baby. I also read Chaput and colleagues’ enlightening article in CMAJ Open on the link between breastfeeding difficulties and postpartum depression. When I recently started talking to new and expecting mothers, I realized that very little seems to have changed in the discourse around breastfeeding and the experience of being a “good” mother since I went through that lonely and painful time in my life. In 2017 we still seem to lack a nuanced understanding of women’s experiences with infant feeding.
In 1995, breastfeeding my son was part of my philosophy on motherhood. I believed that breastfeeding was a rejection of “man-made” products that, in the past, had claimed to be scientifically superior. Women who breastfed were empowered because they, alone, provided the “best” nourishment that a baby needed. Their bodily fluids were not mysterious or dirty, but warm, wonderful and healthy. Of course I planned to breastfeed my baby.
But nothing prepared me for the possibility that I would not be able to breastfeed. By the end of the second postpartum week, my son had lost almost 15% of his body weight and was losing ounces by the day. After his re-hospitalization, I supplemented him with formula.
The realization that it was not possible for me to breastfeed my son exclusively left me feeling completely vulnerable and stripped of my confidence. I was completely disempowered. I had nowhere to turn, nothing to read. I felt like a failure. To add insult to injury, when I did talk to some “breastfeeding experts,” they blamed my failure to breastfeed on trying “too hard” or “thinking about it too much.” I had nobody to talk to about my experiences.
At the time, I had read that bottle-feeding would make my son sick more often, with more frequent ear aches and respiratory problems. Psychologically and emotionally, he would not be as intelligent or as stable as his breastfed peers, a breastfeeding pamphlet told me. Today, aside from a few well-balanced and critically written articles and books, the same messages about children’s psychological, emotional and intellectual well-being are still being conveyed to women, linking not being breastfed with many ills from more frequent infant hospitalizations through problems with mental health in adolescence and adulthood.
It amazes me that in over two decades, health professions education has done so little to help women who cannot or will not breastfeed, for whatever reason, understand that health comes not only from breastfeeding but also from an informed mother who is in control of her circumstance. We continue to use powerful, emotional words to describe infant feeding. For example, describing breastmilk as “the best” milk, as the “healthiest” and “exceptional” milk, while implying that bottle feeding is “unnatural” and “foreign” reflects the perceived superiority of one feeding method over another. The idea that “breast is best” is so pervasive that it has become a taken-for-granted truth. The glowing descriptions of breastfeeding and the demonization of bottle feeding have become so normalized in the literature that they seem to be incontestable. Pulling away the descriptive words that are attached to particular methods of infant feeding exposes the political nature and the hidden agenda within the literature.
Gordon, in her 1989 book “Choosing" to breastfeed: Some feminist questions. Resources for Feminist Research. points out that “hundreds of women did not independently arrive at the decision to breastfeed. They were encouraged to make this choice by the people who provided them with advice and care.” Healthcare professionals should recognize biases in the literature that arise because the very diverse nature of women’s experiences with infant feeding are largely ignored. At this point in time, both the medical establishment and other less medicalized communities are in agreement that “breast is best” and offer little else in terms of advice. As a result, some women may fall through the cracks and may not recognize problems associated with feeding their infant. There is often no safe place to go for advice. I hesitated to take my son to the hospital because I did not want to believe (or admit) that I was having a problem breastfeeding. I felt incredibly inadequate – first for not being able to breastfeed and, afterwards, for denying him the medical attention he needed right away. I worry that women will not know what to do or where to go given the hidden curriculum around what it means to not breastfeed exclusively.
I encourage healthcare professionals to take a reflexive stance toward infant feeding. More needs to be done in health professions education to expose the hidden or unacknowledged assumptions within the breastfeeding discourse regarding how women “should” feed their babies. When breastfeeding is supported almost exclusively by the medical community and society, the social pressure to breastfeed becomes enormous. The emphasis on breastfeeding creates a kind of subculture in which membership is required. Those who do not breastfeed are alienated from other mothers who do, and from a society which supports and encourages breastfeeding, while disregarding all other options.