THE WAY WE FEED our babies is not only a choice we make for ourselves as individuals. It is a political issue, too. For decisions about infant feeding made in the rich world construct goals which women in the poor world strive towards.
In societies where social mobility is possible between a poverty-stricken peasant culture and a much wealthier urban culture, to feed a baby with artificial milk has become a public demonstration that the parents can afford the best. It is an economic statement about their value and the value of the child to them.
Bottle-feeding can be a deliberate choice made by migrant women seeking to adjust to an alien culture. Asian mothers in northem industrial cities whom I have talked with about feeding say quite simply: ‘We wish to do as your women do.’ They rarely, if ever, see a white woman breastfeeding in public. And the lower-income white women they are most likely to get to know as neighbours or co-workers are the mothers least likely to breastfeed. Often they are not even aware that white women breastfeed.
For breastfeeding has become a largely middle-class phenomenon. Low-income mothers bottle-feed because they do not want to deny their babies the best that money can buy. In a consumer society oriented towards mass-produced goods, there is an obvious and ever-growing market for baby products of all kinds. (Mothercare, a chainstore specialising in baby products, had its best financial year ever in 1980, and has just been snapped up by Habitat, a company promoting a young, ‘modem’ lifestyle.) The fact that artificial milk feeding and the early introduction of ready- prepared factory-produced solid foods are status symbols is fully exploited by the baby food manufacturers.
A recent study of 30,000 mothers by the New York Health Department showed that, in 1980, 56 per cent of mothers who delivered in private hospitals in New York City intended to bottle-feed their babies. But in those hospitals where the mothers were from low-income groups the proportion of mothers intending to bottle-feed rose to 82 per cent And as some of the women who planned to breastfeed didn’t succeed, 94 per cent of the lower-income women in fact bottle-fed. Further, the proportion of bottle-fed babies in the private hospitals had dropped by 6 per cent in the past year, while it had risen by 3 per cent in the hospitals caring for low-income women.
Various kinds of obstetric intervention, such as induction and acceleration of labour with oxytocin, can result injaundiced, sleepy babies who are roused with difficulty to feed and then to do so for only a short time.
Separating mothers and babies, because the baby ‘must’ be in a hospital nursery, also complicates the early days of feeding and may result in a mother never developing confidence in coping with her baby. Babies are sometimes sent routinely to special care baby units after a forceps delivery or Caesarean section even when they do not need specialised care and would be better with their mothers. Still in some special care units, mothers feel they are allowed in only as visitors and that the real ‘experts’ with their babies are the nurses and doctors.
In some hospitals babies are still separated from their mothers for the whole of the night and may be given bottles in the nursery ‘so that the mother can rest’, even when she is lying awake, unable to relax because she is listening for every cry. Though lip service is often paid to breastfeeding in these hospitals, understanding how lactation works and the skills of helping the mother are missing. Nurses wait poised with top-up artificial feeds if a baby cries or does not last three or even four hours till the next breastfeed. Some hospitals hand out complementary bottles with every feed just in case the baby can be persuaded to take more milk.
A few hospitals have stood out against this practice. The Bronx hospital has stopped giving out the packages because, as Dr Katherine Lobach, Director of the Comprehensive Family Care Centre at the Einstein College of Medicine says, ‘Free samples are free advertising,’ A recent study by one company revealed that the formula used in the hospital and brought home was invariably the one the mother used for the next six months to a year.
Mothers often see all hospital procedures as ‘scientific’. They believe that a great deal of research must have preceded the introduction of any procedure and that any hospital practice must be better than anything they would do spontaneously for their babies. A seventeen-year-old simply said, ‘The doctor here picks the milk for the baby.’ Another mother said, ‘You have no choice. You take what they give you in the nursery. No one asks you.’
The decision whether or not to breastfeed is part of a much more complex pattern of behaviour in which institutionally-imposed passivity, integral to the role of being a patient in most hospitals, is extended through childbirth into the post-natal period. This probably affects feeding as much as it does the acceptance of drugs in labour, immobility and the supine position in childbirth, intravenous oxytocin drips and the whole system of interventionist obstetrics.
Perhaps it is only when women who have previously taken no part in decision-making about their bodies come to realise that they have choices about the kind of labour they would prefer that they will be able to make active choices about how they feed their babies.
A mother needs to be confident about her ability to breastfeed and about her body if she is to establish breastfeeding. Failure to get the baby firmly fixed on the nipple, which needs to be drawn into the back of the mouth, is probably the major cause of difficulty in breastfeeding, If the baby is not positioned to press on the milk ducts, which lie like a bunch of grapes just behind the brown circle around the nipple, the areola, the baby can only get the foremilk. This is the milk which is just behind the nipple and is merely an hors d’oeuvre. Once the baby’s palate has been titillated by the delicious taste of what is to come, the spontaneous, vigorous sucking of an eager baby in the correct nursing position produces rhythmic squeezing on these ducts. This in tum stimulates the let-down of the milk, which is then actively squirted into the baby’s mouth. With nutritional sucking, as distinct from comfort sucking— both pleasurable activities for a baby — the jaw muscles can be seen working. It is easy to check the correct position because with nutritional sucking the baby’s ears wiggle!
It is not enough for a woman just to produce milk. It has to be made available to the baby. That is a cultural act and a learned response, usually achieved through observing other women breastfeeding. In our own culture girls grow up with little chance of seeing babies at the breast and even of handling small babies themselves. As a result, learning how to breastfeed seems to many women an esoteric skill, and the learning process can be painful and complicated.
One of the reasons often given for lower-income women bottle-feeding is that they are under pressure to get back to paid work without their babies. It is possible to breast-feed and work, even when nursing facilities are not available. But a mother needs good counselling and to be highly motivated if she is to express milk with a breastpump when at work — the only practicable way to continue breastfeeding if she is to be separated from her baby for the length of a working day. For her breasts need the repeated stimulation to continue making milk.
If women were able to breastfeed as a matter of course wherever they happened to be when their babies were hungry (if, for example, shops and public places offered some comfortable seating and a welcoming notice for breastfeeding mothers) not only would it be of direct benefit to these mothers and babies but more young people would accept breastfeeding as a natural part of our lives. They would absorb through their senses, almost unconsciously, the ways that mothers handle their babies.
Only a few weeks ago I heard of a woman who put her baby to the breast while waiting in a government welfare office, and was told she must leave. Other mothers, attending their post-natal check-up (in several different hospitals) where they delivered their babies, have been told that they must not breastfeed there! It is ludicrous for hospitals to say that they encourage breastfeeding if they make it impossible for women to breastfeed unselfconsciously.
Breastfeeding is not a choice a mother makes just for her own baby. She makes it, indirectly but powerfully, for all other babies, and most of all for those in the Third World, whose very survival depends on getting human milk.