100 Reasons Why Women Stop Breastfeeding

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 model
This how you breastfeed right?

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.

 

Resources

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/

Pregnancy in Palestine – why boys are preferred and dates are delicious.

cute muslim baby

(Cute Muslim baby! Don’t research images with the word Palestine in them btw, it’s most upsetting)

A friend of mine who doesn’t plan on having children has often described me as ‘taking one for the team’. She doesn’t want kids and nor do most of our shared friends so she’s glad I have done my bit. In Palestine this is taken to another level entirely. Having children isn’t just a matter of personal choice but a duty to the whole community. This is both part of a longer tradition of emphasising community over individualism but also it has a great deal to do with politics in the region. Palestinians feel it is their duty to have as many (ideally male) children as possible as a way of asserting themselves in the region and protecting their future.

Getting asked ‘Is there anything on the way?’ therefore, is part of the newly weds daily conversation almost straight after marriage and most women get pregnant within the first year of marriage. In the research I read the women described it as a way of stopping the constant questioning almost more than anything else!

Continue reading

Fat Vaginas and Hot Springs – being pregnant in Japan

 

japanese pregnant women

(Slightly condescending image of pregnant Japanese women; it was this or stock shots, sorry)

Do pregnant Japanese women eat sushi? The quick answer to that is yes, they do. The longer answer is that as a developed nation with modern medicine and the kind of modern economically privileged lifestyle we are familiar with the fact that pregnant women are not told to avoid raw fish is one of a number of recommendations that makes it clear how medicine along with all human endeavour is culturally mediated and some recommendations have more to do with culture and tradition than medical science. And that medical science is inextricably tied up with culture so it’s hard to separate the two anyway.

For example, here in the UK and across much of the West pregnant women are advised not to overheat. When I was pregnant with my first child we decided to go on a big holiday before all the fun was extinguished from our lives (as we feared). We went to California, hired a camper van and went on an amazing road trip. When we stumbled across some natural hot springs my excitement was ruined by the recommendation that pregnant women were not allowed. Signs around the springs stated: Continue reading

What Shouldn’t You Eat When Pregnant?

baby-sushi

No raw egg yolks, no unpasteurised cheese, no sushi etc etc. Are women everywhere given restrictive diets? Basically the answer is yes but what is restricted varies hugely. In parts of Thailand papaya salad, pickled food, spicy hot food, coffee, tea and shellfish are all to be avoided. In parts of Madagascar peanuts, bananas and milk are taboo. Masaii women have traditionally followed a near starvation diet for the last months of pregnancy with very little meat intake and induced vomiting. The intention is to reduce the size of the baby and allow for a safer birth. Unfortunately, as you can imagine, the neonatal mortality rate is particularly high.

Amongst the Huoarani in Ecuador, pregnant mothers don’t eat fish or most types of meat towards the end of their pregnancy too but what is really interesting is that expectant dads don’t either. Expectant couples see themselves as ‘one flesh’ so it’s vital that fathers participate to ensure their child’s good health. Laura Rival writes about how she observed one occasion when a pregnant mother was prescribed vitamins by a visiting doctor and she shared these with her partner too. It’s interesting to see how both parents are encouraged to take care of themselves, not just the mother, and that the father’s body is part of pregnancy too.

I really wanted to eat poached eggs so took the salmonella risk seeing as it seemed extremely unlikely and also drank small amounts of alcohol as the NHS at the time said that was permitted and did the same with my second even though they’d changed their advice by then. I would think that most mothers don’t always stick to all the rules however, it’s well documented that French women do avoid unpasteurised cheese even if Japanese women do eat sushi, so I would err on the side of caution and follow NHS guidelines as much as possible.

Laura Rival article on the Huoarani

Madagascar Health research (not anthropology)

Madagascar pregnancy and gender article – Rita Astuti

Fun article in the Guardian with loads of anecdotal stories in the comments

Birthing Partners

 

Husbands or partners getting involved during labour and at the moment of birth is a relatively new phenomenon in the West (although there are exceptions, aristocratic men in Britain for example, notably Prince Albert, attended their children’s births). Traditionally midwives or later on doctors would attend births with fathers pretty much entirely excluded from the process until the 1960’s. However, it seems like it’s not just modern Western men that get involved. Huoarani fathers to be are also their wive’s midwives (midhusbands?!)

Expectant fathers are the main or only support during their wife’s labour, massaging their backs and applying pain relieving leaves to their stomachs, back and temples. They may even reach inside if for instance the umbilical chord has wrapped around the baby’s neck and once the baby is born they will also cut the umbilical chord. After the birth they will restrict their diets in the same way their wives do and stay close by.

This mirrors their attitude to their community as a whole. If a member of the long house (even if they don’t actually live in long houses anymore) gets ill then the whole community may follow a particular diet until the patient is better. Long houses but couples especially may consider themselves ‘one flesh’ in this regard.

So if your partner complains about attending ante-natal classes, or is out drinking as much as they can ‘while I still can’ point out that some people view pregnancy and birth as a team and how about giving you a massage instead.

With thanks to Laura Rival for this article.