There are many reasons women stop breastfeeding but one of the most common is that they say their milk either ‘dried up’ or they weren’t producing enough. However, if you delve a little deeper every woman will have a story particular to her that explains why she stopped and it is usually much more complex than there just not being enough milk. There are in fact way more than 100 reasons why women stop breastfeeding but what I want to discuss in this post is what ‘not enough milk’ means and why it happens so much more than medical research allows for, i.e. I found scant evidence for physiological causes of low milk supply in my research.
Breastfeeding is a perfect example of how you can’t look at human activity in isolation from its wider context, whether it’s breastfeeding or mathematics, what we do is shaped by our surroundings and shared beliefs. Obviously this doesn’t mean there are no bodily facts, breastfeeding can only be done by women with breasts (apart from the men who breastfeed but let’s not complicate matters), but I wonder if the tendency to just look at breasts and breast milk as almost separate from the woman herself has skewed our understanding and our experience of this essential activity.
Looking for images about breastfeeding for example google rarely brings up any pictures with women in a social situation, it is almost always just the breast and the baby without the rest of the woman!
This reveals the cultural bias in the West to see breastfeeding as biological and nutritional but not social. This explains why so many women despite knowing that breastmilk is superior nutritionally, on a social level it is still an awkward thing to do and in some situations it is actively disapproved of as the poet Hollie McNish expressed so eloquently.
We see breastfeeding as a slightly embarrassing nutritional, biological activity but how do we see nutrition and biology? There are strong arguments that industrialisation and the Enlightenment both contributed to an idea of the body as a machine, a series of processes a bit like a factory, separate from the mind and one that can be understood using the language of economics. What does that have to do with breastfeeding? Well just look at the language midwives and mothers use.
In an ethnographic study in the north west of England the anthropologist Fiona Dykes found several words kept being used by those she spoke to: producing; supplying; demanding; controlling and productive. Only one woman spoke of breastfeeding using terms like intimacy and nurturing and she was from Gujarat. Nurturing and intimacy imply relationships not just inputting nutrition by providing the right quality and quantity of milk at the correct times. Terms like keeping up your supply, not giving in to controlling babies using you as a dummy (aren’t dummies supposed to be mimicking breasts, not the other way around!?), on demand feeding, producing enough and so on, all contribute to an idea of breastfeeding as a production line. It’s no wonder that some women feel they are failing and have anxiety about ‘producing enough’.
Another ethnographic study in the UK, completed recently, highlighted the effect of regular weighing of newborns. What it discovered is that the centile charts and the often weekly weigh ins were causing unnecessary concern in both health professionals and mothers which often resulted in the introduction of formula. The centile charts used by most health visitors and midwives are based on US formula fed babies. This new study reveals that breastfed babies do have small fluctuations in weight: some weeks they may decrease in weight and others they’ll increase. I emphasise that these are small discrepancies and if you are advised to consider formula this may well be the best choice for you. But it’s another reason why some women stop breastfeeding based on the feeling that there are correct weights, volumes, supplies and demands when in fact they may be doing just fine.
I want to make clear that I have no desire to diminish the real experiences of women who did not have enough milk for their babies. For many women it does not feel like a choice but an absolute necessity and I have no wish to put their experiences into question. As I expressed in a previous post, bottle feeding is just as natural as breastfeeding and there is no judgement here.
I have a million other things to add and I hope to continue this topic but for now let me finish on a health initiative undertaken in India with 299 women who all came to the medical centre with concerns that their babies were not getting enough milk (it’s definitely not just a Western worry, it’s incredibly common across the world). After 3 months they were all discharged and were exclusively breastfeeding their babies. What did they do? All the usual strategies of correct latch etc that you’re probably familiar with but two further things stand out. Medical staff were told not to use words like ‘wrong’ ‘right’ or ‘enough’ and grandmothers were actively encouraged to advise and support the young mothers. This was because as the report outlined, ‘Casual comment by relatives or health professionals that the mother may not be having enough milk may be sufficient to reduce the mother’s confidence, suppress oxytocin reflex and cause lactation failure’. These women were spoken to in a positive non quantified way and their social relations and context were taken into consideration. I wonder if we can learn something from this project here in the UK.
I read loads of different articles for this post so if you have any questions just ask and I’ll send you the relevant papers.
If you’re struggling to breastfeed then see what your local health visitor or midwife can provide, lots of boroughs and counties have excellent specialist lactation support. If you don’t have access to that or it’s not working for you La Leche League provide excellent if slightly biased advice. This is the UK site but there are groups all over the world https://www.laleche.org.uk
If you want to try mix feeding or switch to bottle feeding here’s some excellent practical advice on bottle feeding technique: http://nurturedchild.ca/index.php/pumping-bottle-feeding/bottle-feeding/