Soon he forgot his embarrassment and became mesmerized by the slow rhythmic sucking.
Michelle Magorian, Goodnight Mr Tom, 1981.60
Just as I was on the last edit of this book, a study of 2500 Western Australian children followed over 14 years found that those who were breastfed for more than six months had lower rates of aggression, depression and anxiety than those who were not.61 All of this adds up to significantly better mental health — happier kids, in other words. So why does breastfeeding make such a big contribution to a child’s self-regulation skills? No-one has come out with a definite answer. I’d like to speculate here and say, beyond being the right food for babies, these mothers and babies often have more body-to-body contact, which (as we saw in Chapter 8: Empathy and your baby’s sense of self) develops into stronger empathic skills.
So I knew I had to talk about breastfeeding but I discovered I had a tremendous aversion to doing so because, unlike most other aspects of parenting, breastfeeding is something that it seems not everyone can do. Once upon a time nearly every Australian woman could breastfeed, of course, just like they currently do in Russia and Norway. But not now. I didn’t want to make anyone feel guilty!
And yet, I do believe passionately that women need every bit of good information they can find. Perhaps I believe this so passionately because, despite looking very hard, I wasn’t able to find that good information when it came to giving birth. It took me 55 hours of full-blown labour to give birth to Tim and only right at the end was I given syntocin. I took a year to recover from giving birth to him — not mentally, but physically. So I was wary when it came to birthing Sam and wondered if, perhaps, a Caesarean would be better. ‘Oh yes!’ was the response from the doctors. None of the risk factors of a Caesarean in terms of later births or for the babies themselves were discussed.
It took me about eight months to recover from that Caesarean. Later I found more information on the risk factors to babies of Caesareans too. So when it came to Rafael I thought that I would try for a normal birth. I could try, I was told, but I would not be allowed to use syntocin as the Caesarean scar could rupture. Without that help, though, I wasn’t able to labour properly and I had another Caesarean. Just two months after he was born I heard that only some doctors won’t allow use of syntocin in the case of a vaginal birth after Caesarean. You can imagine the grief I felt at hearing that. I am very good at ferreting out information, but despite reading, researching and talking to other medical people I hadn’t found several critical pieces of information in time.
So I hope no reader is reading this chapter and feeling guilty. Guilt implies that something was your fault. Our society makes it very hard for women to breastfeed, so this is not a matter for guilt. But sorrow and grief: these, too, are hard emotions to live with.
So why is breastfeeding something that fewer and fewer Australian women are able to maintain, despite the fact that 90 per cent of us initiate breastfeeding with our newborns? Along with much of the other knowledge about child-rearing, breastfeeding wisdom has disappeared from the community as a whole and is held only by a few professionals. And, on top of that, breastfeeding is very tricky, especially at first.
For the very first feed, if possible, encourage baby to crawl up your body to find the breast. If a newborn baby is placed on his mother’s stomach he will ‘crawl’ using the stepping, rooting and sucking reflexes to find the nipple and attach. For the first 15 minutes or so he will just lie there, but before an hour has passed he will find his way to the nipple all by himself.62 Continue to lie baby next to your bare skin as much as possible, and get him to do some of the latching-on himself — but have that attachment carefully checked by a midwife.
Having your baby latched on correctly is utterly critical to successful breastfeeding. I recommend that you ask for help attaching baby from an experienced midwife at least a few times every day for the first few days. This is especially important if you’ve had a C-section. Even if you’ve breastfed successfully before, don’t be shy of asking for assistance. Even with Rafael, where I had four plus years of successful breastfeeding experience, I still insisted on help for those first days with getting him properly attached. (My friend Kate advises you to look for the older midwives to help: breastfeeding skills are not necessarily something that younger midwives have had a chance to develop, with fewer and fewer women breastfeeding and shorter and shorter hospital stays.)
When your baby isn’t ‘on’ properly it leads straight to blisters and cracks of the nipple. (Some great advice on healing such injuries can be found on the KellyMom website.) Cracked nipples are apparently (I’ve never had one due to my insistence that the midwives attach my sons to my breast) terrifically painful, so it is really worth the embarrassment of refusing to attach your baby yourself for a few days after he’s born. Both you and the baby learn what a good attachment feel like this way.
I have, however, plenty of experience with both thrush and mastitis to share with you. If latching on is terrifically painful, but after the first few sucks that pain disappears (until next time) you and the baby have thrush. Anti-fungals for both you and your baby are required — and they work very quickly. Just a day later the pain is a distant memory.
I associate mastitis with bras that are either too tight or too loose. If you are having repeated incidences of mastitis, get a new bra. Occasionally I’ve felt ‘fluey’ and missed that it was the beginning of mastitis — if you are breastfeeding and start to feel very unwell, always suspect mastitis as a possibility. Check your breasts for streaks, lumps and hot patches — and get to a doctor immediately if you feel it could be mastitis. You need to obtain antibiotics urgently as mastitis develops and worsens very rapidly. (Cabbage leaves will help here too.) Many women I know say that mastitis becomes more of a problem with successive babies.
If anything at all is bothering you, just ask for help. In fact, assume that you are going to need help. Breastfeeding is not something you will innately know how to do. Perhaps once, when we grew up with breastfeeding all around us, we might have known, but today, where the dominant image is of a baby sucking on a bottle, we are a long way removed from that.
Breastfeeding is also very time-consuming initially. A breastfed newborn may feed up to twelve times in twenty-four hours — and each feed may take quite some time. You and your partner need to be clear that getting breastfeeding well established is a great deal of what you will be doing for some months after the baby is born.
My sister Stephanie has struggled with breastfeeding with each of her three sons. With the two eldest boys (now eight and four) everything went well at first, and then, at about three months old they were diagnosed as failing to thrive. She now says that she realises that they had been somewhat underweight from very early on but that the situation became far worse at this point. She feels that this was when she began pushing herself to ‘do more’, coupled with the first round of immunisations, which led to them sleeping more and feeding less. Breasts are very sensitive to demand — if it decreases, they promptly produce less.
Her decreasing milk supply was also distressing for Steph, and that distress caused her milk supply to drop further. (I remember one day when Declan spat milk back up: ‘there’s not enough of it for you to do that’ she said sadly to him.) Breastfeeding is a confidence game.63 Milk supply is a key to confidence. When there’s less, you feel less confident. Less confidence means more stress and less supply. The way to reverse this is to spend all your time with your baby either nestled up to you, skin to skin, or feeding. If they aren’t feeding enough to build up supply, then you need to use a breastpump to tell your breasts to produce more milk.
Put simply, for those first three months, women who want to breastfeed need to spend the majority of their time doing just that. To support a friend or partner who is struggling to breastfeed, do her dishes for her. Play with her toddler. In this way she can let go of all other concerns and simply have loads of skin-to-skin contact with her baby.
In addition to being very time consuming and ‘technically challenging’, breastfeeding is difficult for other reasons too.
We haven’t just lost a lot of breastfeeding knowledge out of the community, we also have replaced that knowledge with disinformation. Even the phrase ‘breast is best’ gives the wrong message. It sounds as if breast milk has added extras and formula is normal. Breastmilk is normal. Another of the classic pieces of disinformation is that women are told they shouldn’t feed their babies off to sleep, and that for ‘good’ deep sleep for both themselves and their child a bottle of formula works better than a breast. In fact, you don’t want your baby to have the same kind of ‘deep sleep’ you see in older children and adults. Feeding babies formula (quite apart from all the other risks) increases their risk for sudden infant death syndrome because they are ‘sleeping deeper’.
Parents worry terribly about getting enough sleep. This is entirely reasonable, as getting too tired puts you at risk for postnatal depression among other things. But why then are women told that they shouldn’t feed their babies off to sleep? It is an extraordinary statement, particularly considering the fact that breast milk is full of sleep-inducing hormones.
And does breastfeeding really mean that mothers get less sleep? No. In fact, research shows that breastfeeding increases sleep in parents by 40 to 45 minutes. The writers of the report on breastfeeding conclude, ‘parents who supplement their infant feeding with formula under the impression that they will get more sleep should be encouraged to continue breast-feeding because sleep loss of more than 30 minutes each night can begin to affect daytime functioning, particularly in those parents who return to work’.64 Breastfeeding parents get more sleep.
Another disincentive to breastfeeding is the fact that women who breastfeed in public can be harassed. I remember feeding Rafael at a road house and two middle-aged men walking past with one saying to the other, ‘Tits a fine day’. What did I do? Nothing. I was so overtaken by rage and shame that I did not respond, although many responses have occurred to me since.
Part of ‘breastfeeding confidence’ is knowing that it is okay to breastfeed anywhere, anytime. Unfortunately, this is not what happens in the media at the moment. Instead, women as individuals are pilloried for the decision not to breastfeed. And it’s very wrong reasoning. If women are harassed for breastfeeding in public, the blame lies with the society that allows this harassment.
So why is there such a level of disinformation in the community? Why don’t we better support women to breastfeed? There are two reasons.
The first is that in Australia commercial interests have shaped our ideas of how babies should be fed. The bottle has become the symbol used by pharmacies and supermarkets to indicate their interest in being seen as ‘family friendly’. This has become so ubiquitous that it is not something I even noticed until blogger Lauredhel (whose various writings have provided much of the material for this chapter) pointed it out to me. Over the last 50 years Australians have come to regard formula feeding as ‘normal’ and breastfeeding as ‘extra’. This is a triumph of marketing. The reverse is true: breastfeeding is normal. In fact, feeding babies infant formula is very far from being either normal or benign. A range of serious health consequences flow from feeding babies infant formula. The best known of these are the greater risks for cot death, diabetes and obesity. There are other risks also, including greater risk of developing allergies and asthma later on, and more illnesses in infancy.65, 66
The World Health Organization has developed a code of practice for infant formula manufacturers. It bans them from advertising and claiming health benefits for formula, and also from giving free samples to women able to breastfeed. Australia has signed this code, but has not enforced it in legislation. Instead, there is a ‘voluntary code of practice’ which is co-signed by formula companies.
Every infant formula advertisement acts as disinformation to the women who read it. The manufacturers continue to present formula as an equivalent alternative — not the best option, they say, but close — when the two are worlds apart. So while the WHO code of practice bans companies from using labelling that ‘idealises’ the use of breast milk replacements, it still is occurring. You will see phrases like ‘keeps little tummies happy’. Imagine the distress of the mother of a baby with colic who weans her baby, only to discover after two weeks on formula that her child’s colic is worse! This is human suffering for commercial gain, and needs to be clearly seen as such and legislated against.
The second reason why women are not better supported to breastfeed is that we, as a society, don’t offer them any alternative to returning to work as soon as possible after they have given birth. Where women have long paid maternity leave — for example, in Norway — sustained breastfeeding rates are over 90 per cent. In Norway, maternity leave is either ten months on full pay or 12 months on 80 per cent pay. There, when women return to work they are allocated two hours extra on top of normal breaks to breastfeed their child.
So when Stephie’s milk supply all but dried up in the third month and I watched her struggle — the baby getting thinner, her distress when the paediatrician told her that in another baby he’d diagnose ‘failure to thrive and neglect’ — I knew utterly that the wrong thing to say would be, ‘Well, why don’t you just switch to formula?’ I knew how much she feared having to go through the grief of knowing her baby was missing out on breast milk and losing the breastfeeding relationship she had so wanted to share.
If a woman wants desperately to breastfeed her baby and she is having difficulty doing so, telling her that it is not that big a deal is not going to bring her any comfort. She needs to be supported to find solutions, rather than have her mind changed. And there was a solution for Stephie with her first two babies — it came in a pill and she was able to wean herself off it after a month or so without compromising her milk supply. With her third son she’s managed things very differently.
Callum was a sleepy jaundiced newborn who didn’t suck enough for Steph’s supply to increase commensurate with his increasing needs. And, as my friend Cindy says, newborns ‘don’t know what they are missing’ — they don’t demand that you feed them. So Steph compensated for that missing sucking with the breast pump. After every feed she would pump, so that when Callum returned to the breast there was more milk available than there had been at the last feed. With this happening he was able to ‘feed through’ his jaundice and is now, despite this unpromising start, the plumpest of the brothers at four months of age.
Rather than the usual ‘go on to formula’, Steph recommends that women see what happens if they try pumping to boost supply, and, perhaps in addition to this, ask for a prescription of the travel medicine that also boosts supply. Unfortunately it can be hard to access this kind of support. It seems that women are more likely to have their determination to breastfeed undermined in Australia at the moment. Blogger Lauredhel writes:
When your kidneys fail, it’s a medical drama. You get hundreds of thousands of dollars of medical care, there are kidney associations, there are research foundations and telethons. You get time off work and specialist appointments and medications and dialysis.
When your breasts aren’t working quite as they should?
‘Here, have formula.’67
Ninety-nine per cent of Australian women wean their babies well before the recommended two years. What keeps some of us going? One study of 100 women (many of whom struggled with breastfeeding initially) who breastfed for that time found there were three interconnected reasons. Firstly, these women were hearing and reading enough information about the benefits of sustained breastfeeding to counter the classic Australian belief that ‘they are too old once they can help themselves’. Secondly, they had support from other breastfeeding women. And thirdly, they had joined the Australian Breastfeeding Association, which provided support and connection with other mothers.68
The right information, support and connection to other breastfeeding women made all the difference for Steph and Callum. I went to both the Australian Breastfeeding Association website and the KellyMom website to find information for Steph as she battled to return Callum to his birthweight. More information came from my friend Cindy, who just months before had won the battle to breastfeed her premature, jaundiced son Casey. Steph’s local Child Health Nurse was also a tremendous support to her, recommending and providing her with a breastpump and celebrating with her as Callum went from below the twentieth percentile for weight up to the seventy-fifth. Hurrah!