Pressure to breastfeed

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.

5 thoughts on “Pressure to breastfeed

  1. Gordon Friesen

    Hi Sophie,

    I find your reflections very interesting.

    I also notice that I have run into a couple of other interviews/articles on the same subject lately.

    So let’s recap: Breast is objectively best. That seems to be the consensus, and even you did not dispute that conclusion.

    On the other hand, many women are unable to adequately breastfeed. And another group, to whom you devoted but a word or two have no interest in doing so.

    These, I would suggest, have two very different profiles. The last would fall into the generally self-absorbed and delinquent category, which comprises both men and women who put their own satisfaction ahead of that of their children, or of anyone else for that matter. Collectively, we will always be called upon to clean up behind them and beyond that I have little to say on the subject.

    The first group however, those who would breastfeed but who cannot, have all of my sympathy.

    Although breast milk does have proven advantages, it is still quite possible to raise a healthy baby on formula. And after all, we must make do. We must accommodate reality. (For outside of a certain evolutionary correspondence, reality is not likely to accommodate us.) I myself have four adopted children who were never breastfed. Perhaps they would be brighter or more healthy were that not the case, but they are alive. I love them. They are mine.

    What disturbs me in your discourse, is the perhaps unconscious ableism implicit in the idea that a person subject to a physical handicap, such as a woman who cannot adequately breastfeed, would be somehow happier if encouraged to believe that she is normal.

    The clinical word for that, of course is denial. Denial is fine. It is also, ironically, normal. But it is, in my opinion mischievous and irresponsible to encourage a person in their denial ; and especially to develop an academic narrative which would suggest that facts are not facts.

    Consider: You can’t walk dude. It’s a handicap. Deal with it ! (We must also, of course, model the behaviors of individuals who have done just that. But unless we make the silly assertion that EVERYTHING is normal, we must start by admitting that not-walking is NOT normal and requires abnormal strategies.)

    So now we return to the woman who can’t lactate. I simply suggest that she learn to accept the tribulations of life. No one is perfect. Deal with it. Nourish your child as best you can. Take pride in the fact that you have succeeded in doing so.

    But should that person refuse to admit the handicap as such (after a reasonable period of denial, of course) and should other people assist her in the pretense, well, that is Ableism of the worst sort. And ableism abetted.

    For what is the message for that dude who cannot walk, if people with literally trivial handicaps like the one we are discussing, are pathologically terrified of admitting the truth ? How is he supposed to conceive a positive image of himself in spite of his severe handicap, when supposedly normal ableist people feel required to abet even the barely handicapped in their denial ?

    Why the message is clear : The disabled condition is impossible. Unthinkable. Unassimilable.

    Of course that is nonsense. But that IS what most people intuitively believe (for which they can be forgiven because they know nothing of the matter). But that is also a socially debilitating ableism which really DOES make life more difficult for the dude who can’t walk, or whatever.

    Now, although I promised not to talk about those women who simply refuse to breastfeed, I have realized that there is, in fact, something useful to say: Let us admit that there are also psychological handicaps which would render a woman unable to feed her child. And let us exempt her in the way we have already exempted those whose handicap is physical.

    We are still left with a certain residue of people, sometimes excessively clever people, who simply have no interest at all in the needs of others. And in light of such cases, the academic work aimed at obliquely disputing the objectively obvious superiority of breastfeeding (in order, as we noted, to mistakenly encourage a denial of the handicapped condition in non-lactating women) totally loses its benign character. And that is because, it also enables those people who are simply self-centered egoists to piggy-back on the sympathy we naturally feel for those who are truly unable.

    Of course, this final group, should also be encouraged to outgrow denial. They should also be eventually led to the liberating realization that they actually refused to breastfeed, or quit smoking, or bring home the paycheck on Friday, simply because they did not give a damn. Not because they couldn’t, but because they wouldn’t.

    Frankly, the difference is not difficult to grasp: Consider one person, who must push themselves in a wheelchair, compared with another, who is carried in a sedan chair on the shoulders of others, simply because he or she is too lazy to walk.

    I sincerely believe we should all make a habit of drawing these distinctions. First, because it helps us to show sympathy where sympathy is due (and to refuse it where it is not).

    And also, a willingness to identify our own handicaps, as such, is not only beneficial for ourselves, but the solidarity which naturally flows from such an understanding cannot fail to make life that much easier for others around us.

    Feel the Love,

    Gordon from Montreal

    Reply
  2. Brady murphy

    Thank you Gordon for exemplifying the exact attitude that Sophie laments in her column. Your comment is akin to a blunt instrument with which to beat someone over the head with. No nuance. Even if I agreed you were accurate in your consideration of supporting women unable to breastfeed as ‘ableism’ (which I don’t) you seem to have completely overlooked that fact that a large percentage of women unable to breastfeed are due to lack of access to/availability of adequate support services. Much of the guilt felt by mothers unable to breastfeed seems to come from the feeling that it’s something that should be intuitive and that difficulty suggests an inherently inadequate mothering instinct and/or mothering skill. Truth is, most people would benefit from more support than the typical postpartum breastfeeding support given in Canadian institutions/public health nursing. Your comparison to a man unable to walk is pretty inaccurate and entirely unhelpful. Would you still cry ‘ableism’ if the reason the man was unable to walk was because someone tied his shoelaces together? Because thats what we’re effectively doing by inadequately supporting breastfeeding! Are there women who will still be unable to breastfeed despite optimal services? Yes, but far fewer than there would be otherwise.

    The push for ‘breast is best’ has definitely put a huge amount of pressure on new mothers and has certainly created some anxiety around these challenges. Unfortunately our society is also structured to sabotage those who wish to breastfeed but find it difficult or inconvenient. The push for breastfeeding is helping to normalize and encourage something which had been stigmatized for a large portion of our recent history. Breastfeeding in public is still a bit of a crap shoot in many parts of the country. Unfortunately the collateral damage from this is a sense of rejection felt by those unable to achieve success. Let’s continue to optimize and create supports to alleviate that new stigma and recognize that much more can be done to help new mothers experiencing difficulty – even (or even especially) saying “it’s ok”

    Reply
    1. Gordon Friesen

      Dear Brad,

      Look at what I have wrote at the beginning of my letter:

      “The first group …, those who would breastfeed but who cannot, have all of my sympathy.”

      I did not address the question of inconvenience such as perception of public breastfeeding. I apologize. More generally, you state that many women would be able to breastfeed with better support.

      Allow me then, to stipulate that inadequately lactating women (as people suffering from any handicap), should be assisted to the utmost degree in overcoming their deficiency, first by reversing the pathology if possible, and second, should the handicap be irreversible, by providing artificial aides and strategies for achieving the best outcome.

      In every and all cases it is the social duty to provide a welcoming and supportive environment in which the handicapped person can feel accepted, cherished, and especially, emboldened to participate in the public space even when a certain awkwardness might ensue, an awkwardness which it is, once again, our collective duty to minimize.

      Therefore, if I allowed any ambiguity, I apologize once again

      However, when a person really cannot do things that “normal” people do (like a woman unable to breastfeed her children) then that person, objectively, is handicapped, or disabled, or whatever term you prefer. And there is no benefit in pretending otherwise. Denial is not benign. It hurts not only her, but the rest of that large portion of humanity which is, unfortunately, disabled enough to be unable to hide the fact.

      What I lament is that our ableist society creates a Manichean distinction between the “normal” and the handicapped. It is either one or the other. Everybody, naturally wishes to be “normal”. The handicapped person is the “other”, that which I would rather die than be (and quite literally as it turns out when the literature on euthanasia and the handicapped is considered from the usual uninformed ableist view).

      So now, I am not speaking, as a therapist, to some hypothetical postpartum female who would require all of my tact and sensitivity. No, I am speaking to a group of adult readers who, one would expect, have seen some fairly difficult things. In particular, I was responding to an academic suggestion that we should not present the real facts on breastfeeding because it might be upsetting to those who cannot do so. And my message is : No that is wrong. It is wrong in principle.

      If you think a moment, you will realize that we have already decided this issue : We allow sporting events. We have sporting events on TV. We have the Olympics. Obviously, there are a lot of people out there who are never going to run or walk or jump, and for whom even the Paralympics are a constant reminder of just how disabled they are. No one here, I hope, honestly thinks we should try to pretend that running and jumping are not “best”; that we should all maintain such a silly pretense in order to protect the self-image of those who cannot. And it is not only impossible, it is counterproductive. Because if positive self-image is the goal, denial of the disabled condition is not the means to achieve it.

      Which leads back to the subject at hand. Yes, we should be gentle and considerate and patient with the individual before us. But objectively, the inability to breastfeed is TRIVIAL. Get a grip for heaven’s sake !

      So much sentimental dither about how “difficult” it is for these people. I wholly believe you ! Life is hard. It is hard all around. And the adult confidence to live in such a world is the highest achievement to which a human being can aspire. These non-lactating women confronted with a normal human experience of inadequacy are naturally called upon to grow in wisdom. But no. You want to tell them they are normal. Keep them on the “right” side of the great ableist divide. Throw the others under the bus.

      Socially speaking, this issue could be a wonderful thing. It could be like inoculation. You ALMOST get sick. You brush up against disabled pathogens. Your body works out how it would respond if they were REAL. Not only could people charmingly breastfeed babies in public, but the horde of people currently hiding in their homes through fear of dishonoring themselves with bodily excretions of a quite otherwise offensive nature would be emboldened to rejoin the public sphere. But this opportunity is squandered before the alleged necessity of protecting the virtually normal from any hint of disabled contamination.

      Forget ableism.

      What a profound sexism and misogyny are implicit in the suggestion that the average woman is so emotionally and intellectually stunted that she cannot even deal with the idea that she might have a minor disability; the suggestion that we must construct an entire false normality narrative in order to protect her from that knowledge !

      It is ridiculous.

      But it is also as I have tried to point out, pernicious.

      Feel the Love,

      Gordon from Montreal

      Reply
  3. Pol Morton

    Thank you for your letter, Dr. Soklaridis.
    I agree with your sentiments.
    It is right that we as a profession encourage breast feeding. However we do so with such passion that we leave many women with the impression that if their breastfeeding is unsuccessful that they have failed their child and failed a crucial test of motherhood. The psychological toll of this perceived failure is different for different women.
    In my career as a family physician I have found myself supporting several mothers whose babies lost weight until breast feeding was supplemented by bottle feeding. The psychological effect for some women is devastating. They had been bombarded with messages about the benefits of breast feeding while bottle feeding was portrayed as synonymous with poor mothering.
    The prenatal consultation would be a good place to address this. I believe that at the same time we encourage breast feeding and offer every support available to achieve this we need to point out that for a few ladies it simply does not work out and that this in no way diminishes their abilities as a mother.

    Reply
  4. Faye Chow

    As I was a physician for some time before I became a mother myself, your story resonates with me. It is difficult to accept an alternative when your body does not operate as is expected by society and biological fact.

    I, too, was blindsided by the unanticipated fact that my body was not producing adequate milk to nourish my son. I was dealing with post-operative pain, lack of sleep, an unhappy baby, parenthood in general, responsibility for anther person’s future, how my partner fit into all of this, and the niggling fact that I “should” know what to do both from my medical training and the fact that I was born a female and this was what I was designed to do.

    I agree that we as a society do a disservice to expectant mothers in general in not providing a balanced view of what to anticipate. As with most things, somewhere between “Breast is Best” and “Baby formula is an evil corporate product” lies the truth.

    Many thanks for bringing up this important topic that was very dear to my heart.

    Reply

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