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TWO

Lactation Failures

There’s a startling disjunction between how breastfeeding is presented—as a natural, instinctual act that is seldom sullied by physical or emotional impediments—and the actual lived reality of most early breastfeeding experiences. This has created a breeding ground for serious problems, where lactation “failure” is mishandled, misdiagnosed, and misinterpreted. The true failure, however, may be on the part of well-meaning but dogmatic care providers who refuse to acknowledge that legitimate lactation problems can and do exist.

Like many women, my initiation into breastfeeding was exceedingly technical, supervised, and regimented. During our time in the hospital, I was visited by three different lactation professionals (a mammary-centric version of the three wise men—instead of frankincense and myrrh, this holy trinity brought lanolin and breast pads), all of whom approached our breastfeeding “dyad” as if it were not a living, breathing mother and child, but rather two disembodied nipples and a free-floating tiny mouth. I welcomed these clinical ministrations, though, because despite a brilliant opening-night performance, our breastfeeding relationship had quickly deteriorated. If breastfeeding was a dance, Leo seemed to have forgotten his steps and I had two left feet. Or at least one left breast that functioned, and a right one that refused to cooperate—I apparently had some vague form of “nerve damage” that caused severe pain to shoot through the right side of my body whenever Leo would suck. Adding insult to (literal) injury, my infant son refused to latch on to the “good” breast, repeatedly pulling off of it and screaming as if someone had stolen his puppy.

None of the lactation consultants could get my son to successfully latch. The excuses ranged from a kind but vague “he’s just sleepy, give him time,” to the snippier proclamation that my new babe was “a slow learner.” And although no one solved our problem sufficiently to make an actual feeding possible, every two hours, a clipboard-wielding nurse would march in and demand notification of how long Leo had fed and on which breast, and how many diapers he’d soiled. (I realize these nurses were just doing their job, but at the time I could have killed them all, even if it meant ripping out all my stitches to get out of bed and bash them over the head with one of those stupid clipboards.)

Considering how overtly medicalized the breastfeeding experience has become for most of us, it’s ironic that the discourse around infant feeding so often coincides with an anti-interventionist approach to childbirth. Aside from the Nestlé scandal, a large part of the resurgence of breastfeeding in the late twentieth century can be credited to the women’s health movement of the 1960s and 1970s, which raged against how the current medical system was taking motherhood out of the hands of mothers.¹ At the time, breastfeeding was a radical, subversive act; now, it is professionally monitored to a greater extent than most pregnancies.

Breastfeeding has been politicized for a long time—most historians credit the eighteenth-century French philosopher Jean-Jacques Rousseau with framing breastfeeding as a civic duty, a way for women to support the health and moral character of the nation²—but it wasn’t until the nineteenth century that medicalization of nursing and childbirth really became a significant phenomenon, thanks to a confluence of events. The industrial revolution changed the dynamics of American society: women, especially poorer women, were joining the workforce in droves, making it difficult to balance breastfeeding with employment. Wet nursing fell out of favor in the United States; although it was still a viable option for the very wealthy, it was not for the majority of working-class women. Infant mortality rates rose as families began to feed babies unpasteurized milk or other inappropriate substances. At the same time, pediatricians grew fed up with their specialty being considered a “lesser” sort of medicine than that of their peers, and sought ways to become more relevant as physicians. By taking charge of formerly domestic issues like infant feeding and childcare, they were able to kill two birds with one stone—they could reduce infant death and illness rates while boosting their professional cred.³

By the twentieth century, infant-feeding practices were the domain of primarily male doctors, who worried that the “highly developed nervous systems” of their middle-class female clients were not conducive to breastfeeding. In response, they began prescribing rigid routines and dietary restrictions for new mothers, and standardizing “well baby” visits and regular weight checks to ensure that babies were adequately gaining weight.⁴

At the same time all this was going on, infant formula was becoming a mainstream phenomenon. Pediatricians often designed their own versions of breastmilk substitutes to give to patients when breastfeeding wasn’t working—not working perhaps, as medical historians like Rima Apple have argued, because of the bad advice and birthing practices perpetuated by these same doctors⁵—and, slowly but surely, capitalism took over. A few companies began marketing infant formulas to the pediatric community, which would prescribe these products to patients as supplemental “relief bottles” or complete replacements for breastmilk.⁶ Women were increasingly reliant on physician expertise as the century progressed, and formula was seen as easy, modern, and possibly even better than breastmilk in an age in which progress and science ruled. (For proof of this, peruse any women’s magazine from the 1950s. The ads come straight out of The Jetsons.)

Needless to say, the advent of medicalized childbirth and pediatric oversight of maternal duties, coupled with the commercialization of infant formula, is universally blamed for the dramatic fall in breastfeeding rates in the late twentieth century. But Linda Blum, sociologist and author of At the Breast: Ideologies of Breastfeeding and Motherhood in the United States, cautions against a tunnel-visioned interpretation of infant-feeding history:

There is ample evidence for blaming the patriarchal medical profession and, in the case of infant feeding, their collusion with the burgeoning formula industry. … This story is, however, more complex than capitalist-patriarchal collusion. The medical profession … [had] humanitarian concerns … and was also acting in response to mothers’ expressed needs. … They wanted freedom from the control biology extended over their lives, including pain-free, safe childbirth and birth control, and they saw medical science as an ally. … Breastfeeding failure was largely an unintended consequence, and it is likely that both working- and middle-class mothers were grateful to have a safe alternative.⁷

Regardless of why the medical model of infant feeding rose to prominence, by the late twentieth century most American women gave birth in hospitals and took advice from pediatricians about how to nourish and raise their infants. And this had some disturbing consequences. Women were often rendered unconscious during childbirth, for example; babies were relegated to nurseries rather than spending their first days in close contact with their parents; and, as Blum suggests, the confidence women had in their own bodies was typically undermined. The women’s health movement stemmed from the fertile soil of this cold, technological approach to motherhood, encouraging women to seek help from midwives and other more “natural,” antiestablishment care providers. Even today, the AAP and independent physicians are often portrayed as ignorant, “prounneCesarean”⁸ (performing unnecessary cesarean sections) and anti-breastfeeding, in cahoots with the formula industry to perpetuate the need for “artificial” feeding.

Grassroots lactivists struggle with the conflict between philosophy and necessity. They blame modern medicine for the advent of our formula-feeding culture, and our fast-paced lifestyle for the severing of familial ties that have essentially created a generation of women who’ve never really seen breastfeeding in action. But these constructs have also been the most useful tools in promoting breastfeeding. The loudest (and apparently most persuasive) arguments for breastfeeding come from respected medical organizations like the AAP and WHO. Scientific research has provided ample evidence to support the perceived need for militant lactivism, and the highly “unnatural” Internet has made it possible for this message to get across to the masses, even those in areas where physicians are not as up-to-date on breastfeeding science. “Breastfeeding advocates often are caught in the odd position of touting the biological advantages of breastfeeding while at the same time … criticiz[ing] medical practitioners for not knowing more about lactation and for providing false information to women,” states Bernice L. Hausman, one of the most respected scholarly breast-feeding advocates. And yet, “much of breastfeeding advocacy itself is indebted to a medical model of demonstrating the contribution that breastfeeding makes to health.”⁹ Contrary to the back-to-basics, mommy-gut mythology surrounding nursing, breastfeeding in the United States, Canada, Australia, and Great Britain is firmly rooted in this cold, blatantly medicalized version of parenthood. Jonathan Wells of England’s pro-breastfeeding MRC Childhood Nutrition Research Centre even argues that infant feeding is a profound example of biopower, “techniques [that] include normalizing judgments which subtly define the properness of an individual’s behaviour, the institutionalisation of knowledge through which individuals are objectified and devalued, and the ‘panoptic gaze’ which subjects individuals to continual surveillance.”¹⁰

Unfortunately, we might actually need all this monitoring to make breastfeeding possible in the world we currently inhabit. In the same article, Wells asserts that “optimal breastfeeding as defined on a medical basis by WHO is neither ‘natural,’ ‘traditional’ or even, possibly, ‘normal’ in a species that has evolved to exploit ‘short-cuts’ in parent-offspring energy allocation.”¹¹ Breastfeeding may still be the best way to feed babies nutritionally, but using the “breast is natural” argument while simultaneously insisting on the need for more medical research, expert intervention, and education hints at a different truth: maybe lactation is becoming an “unnatural” state in the society we live in.

“The propaganda tells us that breast feeding is ‘natural’ … that’s what the word ‘mammal’ means, for heaven’s sake. … We forget, of course, that while, as Homo sapiens, we still possess mammalian equipment, we are no longer repositories of mammalian instinct except in the most vestigial sense,” writes sociologist Susan Maushart in The Mask of Motherhood. “What our fellow mammals ‘know,’ we must learn. … Breast feeding is essentially a vestige of a hunter-gatherer way of life. The wonder is not that it grafts so poorly onto industrialized minds and bodies, but that we persist in trying to graft it at all.”¹²

Breastfeeding folklore invokes the past as evidence for the “naturalness” of nursing our young—“If breastfeeding were so hard, humans would have become extinct years ago”; “If every woman isn’t capable of breastfeeding, what did we do before formula existed?” What women who couldn’t breastfeed did before formula existed was rely on other women who were lactationally blessed; in tribal cultures, this was made possible by what anthropologists call “alloparenting,” a collaborative arrangement where it literally does take a village to raise a child.¹³ This is likely a foreign concept for those of us living in Western cultures. Many of us don’t live near family, and our friends are often busy with their own professional or family lives. Paternity leave is a rarity, so mothers are left on their own with infants pretty much right off the bat. This puts a lot of pressure on moms to iron out the feeding issues, pronto, even though most experts admit it takes up to six weeks to truly get the hang of breastfeeding. My friends whose families were local seemed to adjust better to both motherhood and nursing—even if there were technical complications in the beginning and even if their mothers were no help with the actual breastfeeding (another reason cited by breastfeeding advocates as a reason for lactation “failure” is that we aren’t getting guidance, and in some cases are receiving active resistance, from older generations)—than those of us essentially in the “orphan” camp. Having a screaming baby, bleeding nipples, and little to no sleep (all completely normal occurrences in the first weeks of motherhood) is one thing when you have a mom or sister there to help you through it; it’s another thing altogether when you’re in an empty house, alone with your fears, insecurities, and seemingly dysfunctional breasts.