Quiz:  How do you really feel about breastfeeding? 

4.  What or who most influences your breastfeeding decisions?

         A.  The media. 

            B.  Family and friends.  If they disapprove, I will probably not continue.

            C.  My health care providers

            D.  My partner, but if we disagree I will still do what I feel is best.                     

            E.  No one.  I feel confident in my decision and am not influenced by other opinions.

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             Many factors likely influence your decision to nurse, how you go about establishing and maintaining your nursing relationship, and how long you keep going.  Even if you assert that you are not influenced by others’ opinions,   your experience, knowledge and values are still influenced by the larger culture and society in which you live.

            Say you want to travel to Italy.  Do you rely on the advice of someone who has scarcely crossed the state line?  Do you read promotional literature about Italy produced by a French tourist agency?  Do you go to your own travel agency who specializes in domestic cruises?  Maybe, but the helpfulness and reliability would be suspect.

            Breastfeeding is not much different.  A lot of breastfeeding promotional materials are produced by companies that make formula.  (Would you go to Pepsi to find out why you should drink Coke?)   On the surface the information may appear sound, but probe a little deeper and it’s not always the case. 

            If you are surrounded by family and friends who have had successful breastfeeding experiences, great!  But what if they haven’t?   How do you react when they ask, “Do you need to feed that baby again?  He just ate!”  “The poor thing’s crying.  Do you think you don’t have enough  milk?”  “When are you going to wean that child?  She’s got teeth already!” 

            Most of us value input from those who care about us.  But with myths and misinformation so prevalent in our society, if we are going to let anyone influence our decisions, perhaps they should be from people who have been there, done that. 

            This is even true when it comes to medical advice.  Some doctors and nurses, for example, know a lot about breastfeeding and have a lot to offer nursing mothers.  But not all do.  Just because someone is a pediatrician or family doctor doesn’t make him or her a breastfeeding expert.  In fact, studies have documented that medical textbooks on the subject are often filled with errors and misinformation.  Many doctors freely admit that they don’t have the knowledge, training and experience to adequately counsel breastfeeding mothers. 

            So how do you know who to turn to?  How do you know who or what is credible?  A few general guidelines are:

            ?Don’t rely on literature produced by any source with an opposing interest.  This means any breastfeeding information coming from formula companies probably doesn’t have you or your baby’s best interest at heart.

            ? If you are reading a magazine or other resource that relies heavily on advertising from formula companies, they may feel a certain limit on how free they are to present certain information. 

           ?If you have a male partner, obviously he hasn’t nursed.  That doesn’t mean you don’t want to respect his opinion.  But it’s important to share information with him so that his thinking evolves, too.  He may be wonderfully supportive and willing to help you in any way possible.  But he may also be uncomfortable with breastfeeding in general, have concerns about you nursing in public, not want the baby in your bedroom, or may encourage you to wean before you want to.  Hopefully you can learn together.

            ?Chose health care providers who are breastfeeding-friendly.  Click here for guidelines

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5.  Do you think that your birth experience will (or did) influence your ability to get breastfeeding off to a good start?

         A.  Not at all.  What does childbirth have to do with breastfeeding anyway?

            B.  Only if I have a C-section because that might make it harder for us to nurse right away and room-in together.

            C.  I don’t think where I give birth or who attends my birth will make a difference.  As long as the baby is healthy, nursing will be fine.

            D.  I think some of the more serious drugs might affect how alert my baby is, so I’m going to try to avoid taking them during my labor.          

            E.  Definitely!  And I'm doing everything possible to prepare for an intervention-free birth experience.

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            One of the great myths that our culture supports is that there is no relationship between childbirth and breastfeeding.  We tend to focus so much on the birth itself that it may almost come as a shock to realize, “Oh my gosh!  I have to feed this child!  How do I do that?   

            More and more evidence reveals profound connections between birthing and breastfeeding.   Babies nurse best when they are alert and placed on their mothers abdomens immediately after birth.  In fact, research has shown that in such situations, a baby can often scoot up to its mother’s breast, find her nipple and latch on, all on its own!  This may take about 20 minutes – unfortunately, just at the time when babies are often taken away from their mothers for routine cleaning and other procedures.

            Anything that interferes with this natural state, this normal next step of the birthing process, interferes with breastfeeding.  As lactation consultant Diane Wiessinger puts it, “We were mammals long before we were intellectuals.  We can use our intellect to overcome birth and breastfeeding problems, but it’s much easier if these problems aren’t there in the first place.”

              In the book, Impact of Birthing Practices on Breastfeeding:  Protecting the Mother and Baby Continuum, the authors examine an extensive array of studies on this very issue. Whether or not you have a support person at your birth; your emotions and feelings; the positions in which you labor; your ability to drink, eat, and move around during labor; the use of medication; interventions such as forceps, episiotomies and C-sections; and immediate post-partum procedures and practices all influence the readiness and ability of you and your baby to nurse.

            So…if you want to get breastfeeding off to the best start possible, it makes sense to learn more about the options you have during childbirth.  If for some reason you end up with a medical or surgical birth, you can still nurse, of course.  And if your birth doesn’t go the way you had hoped, nursing may even help you feel better about things.  Just remember that help is available should you have a rocky start.

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6.  Which statement most accurately describes your thoughts about giving birth?

         A.  Why bother with labor at all?  I’d rather have a scheduled C-section.

            B.  It doesn’t matter what I think.  My doctor has told me I have (or had) to have a C-section.

            C.  I’m terrified.  Thank god for drugs!  I want(ed) an epidural as soon as I feel (felt) that first contraction.

            D.  I’d like to try for a natural birth, but I will trust my doctor or midwife’s  judgment about what is best.

            E.  I trust my body to do what it was designed to do and am ready to embrace the experience even though it will hurt.

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            If you’re afraid of giving birth, you’re not alone.  In fact fear seems to permeate the culture of birth today.  The mere fact that in the U.S. almost 1 in 3 women give birth via major abdominal surgery sends the message that our bodies may well be defective, that they are unable to do what they used to do naturally.  And it’s not that surgical intervention has improved overall outcomes.  It hasn’t. 

            A fear of pain is huge.  But there is good pain and bad pain.  Psychologist and doula Lauren Korfine compares giving birth to running a race.  You reach a point where you don’t think you can go anymore.  You’re exhausted, your legs are aching and you’re gasping for breath.  If someone were to drive up and say, “Hey, you’re in pain.  You’re out of breath.  Hop in the car and I’ll drive you to the finish line.  You’ll still finish the race, but without any more discomfort,” would you do it?  Perhaps. But would you feel the same sense of accomplishment?  The same rush?  The euphoria?  Not likely.

            Let’s extend that analogy.  Back up and resume the race.  Think about how it would feel if people surrounded you with criticism.  “You’re crazy!” they tell you.  “What are you trying to prove?  You can’t finish the race.  Just get in the car!”  But you don’t want to and you continue running.  Only you can’t stop for a drink of water and you can only run at one pace.  You can’t slow down or speed up.  And the folks around you say, “If you don’t get in the car you run the risk of hurting yourself.  In fact, you may not be able to run another race.”  As the pressure mounts, that car begins to look more appealing after all.

            Now, let’s replay the scenario.  You’re back in the race but the people around you are cheering you on.  They are there to boost your confidence, help you achieve what you have been preparing for all along.  If you’re thirsty, they give you water.  If you have a cramp, they give you a quick massage.  If you need someone to lean on, they support you.  And all the while they never lose faith in your natural ability to cross that finish line.  In fact, only in rare cases is there even a car there as a back-up.  Are you more likely to finish the race and feel triumphant?  You bet.

            Substitute the process of giving birth for running a marathon and you get a new way of thinking about pain, a new way of thinking about how people at your birth can either support or undermine you. 

            The common phrase used in hospitals today is “active management of birth.”  This means that instead of supporting the natural process of labor, your cervix is supposed to dilate at a certain rate, and if it doesn’t, you will begin to receive interventions designed to speed things along.  But one intervention typically leads to another - a cascade effect - and before you know it you may experience pain that is harder to cope with, your contractions may become less effective, and the stress you feel elevates your adrenaline levels which suppresses the production of natural oxytocin, a hormone that actually helps you cope with labor.   And your baby experiences the stress, too.  All of these factors help contribute to the skyrocketing C-section rate we’re seeing today.

            But if you labor within an environment in which birth is treated as a natural and healthy process rather than a medical crisis (though at times, of course, such crises do arise) you’re body is allowed to do what it is meant to do.  And both you and your baby will benefit. 

            If you’re afraid of giving birth, or if you are putting all of your trust into your health care provider, remember that you have a say in what happens to you.  Consider reading about different ways of approaching birth.  Where you give birth (in a hospital, birth center, or at home) and with whom you give birth (an obstetrician, a family physician, a nurse-midwife, or a trained home-birth midwife) can have a huge impact on what happens to you during your birth, how you feel about yourself and the experience, and the well-being of your baby.  It can also affect your future birth choices as hospital protocol is making it harder and harder for a woman to have a vaginal birth (vbac) after having had a previous C-section. 

            Remember the words of this mother in Colorado, who, in reflecting about the messages she received growing up, says:  “Never did I hear that birthing is empowering, that it takes strength, that a woman’s body is beautiful and resilient.  Never did I hear anything about breastfeeding, that a woman’s ability to produce this incredible liquid is miraculous and should be honored and revered.  We can pump iron and build up our muscles, but the strength of our bodies and the unique things a woman’s body does aren’t acknowledged.”  But after birthing and nursing two children, she adds, “Birth and breastfeeding have empowered me in ways that no career or educational experience has done.  Giving birth taught me that my body has a wisdom all its own and has strength and resilience.” 

            So does yours.

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7.  Which of the following best describes your thoughts about how babies should sleep:

         A.  Babies belong in their own bed, in their own room, and should be taught how to sleep through the night as soon as possible.

            B.  Babies belong in their own bed, in their own room, but parents should respond  to them when they cry.

            C.  Babies need to sleep alone, but should be in the same room as the parents.

            D.  Every baby is unique, each family is unique and parents have to discover what  works best for their own situation.

            E.  Humans are mammals.  Mothers and babies should always sleep together  unless there is some reason preventing it.

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            Where babies should sleep, whether they should sleep alone or with a parent, and to what extent they should be expected to sleep through the night are huge and loaded questions in American culture.  They also have significant implications for breastfeeding.

            It’s important to bear in mind the extent to which cultural values and biases influence how we think about infant sleep.  American culture places a strong emphasis on fostering early independence and self-reliance and a great value on privacy.  This gets expressed in the arrangement whereby babies often sleep in cribs in rooms away from mom – or dad.

            Obviously, nobody will know your situation as well as you do and you will make decisions that work for you and your family.  But whatever you decide, here are a few things to think about as you begin your journey.

            ? Babies are biologically designed to need physical contact during the night.  In fact, it is only in the U.S. and in other similar cultures, that babies sleep away from their mothers in separate rooms.  In most of the world, and for most of history, babies have slept with their mothers. 

           ? Studies of infant sleep first developed during a time when formula-feeding was the cultural norm.  Because babies fed formula sleep more deeply and can go for longer periods of time without eating, it contributed to the expectation that babies should be able to sleep through the night by themselves, an expectation that lingers today.

            ?For all babies, but especially for breastfed babies, many of the struggles we experience are based on our own unrealistic expectations, rather than any immaturity or problem with our baby. 

             So…breastfed babies need to nurse during the night.  The question then becomes, how to meet their needs as easily as possible so that everyone in the family can get as much sleep as possible.  And how to do so safely.

            Studies reveal what most nursing mothers quickly discover:  co-sleeping makes breastfeeding easier.  Having to rouse yourself out of bed every couple of hours quickly becomes exhausting!  Studies also show that because babies who sleep with their mothers nurse more often than those who don’t, it’s a way of preventing breast engorgement and breast infections. 

            Finally, breastfeeding is related to a reduced risk of SIDS.  Formula feeding and solitary sleeping are actually risk factors.  Babies who sleep alone have more difficulty rousing themselves from deep sleep – a factor that may contribute to SIDS.  Co-sleeping babies, on the other hand, tend to follow the sleep patterns of their mothers, helping them develop more mature sleeping and breathing patterns.

            Because studies also show that mothers who sleep with babies tend to nurse over a longer period of time than mothers whose babies sleep away from them, health care providers should promote bed sharing – if done so safely – as a way to promote continued breastfeeding.

            From a safety perspective, bed sharing is not safe for everyone, and how it is done is equally important.  But safety precautions are equally necessary for babies to sleep safely in cribs. 

             The bottom line is this:  breastfeeding, safe sleep, and compassionate parenting are all important.  You may not want to sleep with your baby.  Maybe you will sleep better without your baby in bed with you.  And maybe your family situation is one where that’s a wise choice.  But know the risk factors for bed sharing as well as for solitary sleeping, and then decide what is best for your family.  Children are killed in car accidents, too.  But car seats and other precautions help us drive safely. 

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8.  Your first reaction when you see someone nursing in public is:

         A.  That’s disgusting.  I could never do that.

            B.  I don’t know.  I’ve never seen anyone nurse in public before.

            C.  I’m glad that mother is nursing, but she should find a private place to do it.

            D.  What a beautiful sight.  Good for her for not retreating to a bathroom!

            E.  I not only think it’s great, but I would go up and tell her so.

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          You’re pregnant and company comes to visit you in your home.  Not wanting to draw undue attention to your swollen belly – it does, after all, suggest how you arrived at that condition in the first place – you remain seated discreetly behind the dining room table. 

            If this sounds far-fetched to you, I just described my grandmother’s behavior in 1936.  Thankfully, pregnant women today don’t have to try to remain invisible.  But nursing mothers often feel this kind of pressure. 

            It is, of course, possible to be discreet without remaining invisible.  And if you’re a modest sort of person, there are things you can do to avoid drawing attention to yourself.  Draping a blanket over your shoulder, nursing with your baby in a sling, finding a quiet corner, for example, all may help you feel better about nursing in public.  But if you’re uncomfortable nursing in public, if you’ve never seen another woman nursing, or if you are quick to judge a mother for feeding her baby in a mall or a church, for example, it may be helpful to keep the following in mind.

            ● Breasts are, above all, mammary glands.  And babies know when they need to nurse.  When something is made hard to do, we are less likely to do it or we may give it up before we otherwise would.  If you want to make cookies but have to first go to the store for the flour, wouldn’t you be tempted to just open the Oreos already in the cupboard?  If you struggle to fit in exercise, aren’t you more likely to do so if you don’t have to first drive a half hour to get to a health club?  The point is, if we make it harder for women to meet their babies’ health, nutritional, and emotional needs, those needs just might not get met.  Isn’t it worth an occasional glimpse of skin to benefit the next generation?

            ? Expecting a mother to use formula when in public or to express her milk for such occasions is rarely the solution.  Apart from the risks of formula (click here to read more on that subject) a breast pump is seldom as efficient as a baby at the breast.  Some women could pump enough for a whole play group!  But others have little success with a pump.  Perhaps more importantly, though, babies who are used to being nursed, might want nothing to do with a bottle.  They nurse not just for the milk itself, but for the satisfaction, the connection, the “blissed-out” feeling they get from being close to “the source.”  And mothers nurse to meet those emotional needs, to comfort an otherwise fussy baby.  In such situations, a bottle, no matter if it contains “liquid gold” or not, doesn’t come close to the real thing.

            ? Finally, it’s the law.  Nursing women have the right to nurse wherever they and their babies have a right to be.  Some states have legislation that clarifies that laws  surrounding indecent exposure and lewd behavior specifically do not apply to breastfeeding.  And some states offer legal recourse to women asked to stop nursing.  In New York, for example, it is a woman’s civil right.

Stories about Nursing in Public

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9.  How long do you think a mother should continue nursing?

          A.  Just for the colostrum or the first couple of weeks.

            B.  For a couple of months or until she goes back to work.

            C.  A fixed period of six months or a year.

            D.  Until she and her nursling are ready to stop.

            E.  For two years or more.

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            Your child benefits from nursing whether he or she nurses for three days, three months, or three years.  As lactation consultant Diane Wiessinger explains, colostrum in the first few days provides antibodies, a kind of immunization, and a jump start on his or her digestive system.  Nurse for another few weeks and you help guide your baby through perhaps the most critical part of his or her life.  A few months of nursing helps his or her digestive system to mature.  Continue for six months and you reduce the risk of allergic reactions to formula and other foods – not to mention reducing the likelihood of certain childhood cancers. 

            Go for another few months and you offer your baby normal brain and body development.  A year into the relationship and many of the benefits of nursing will last throughout your baby’s life:  a healthy immune system, for example, and normal jaw development.  These benefits continue into the second year and beyond, not to mention meeting your child’s emotional and psychological needs and developing strong bonds between you and your child.

            But even knowing that there are good, valid reasons to continue, you may still feel an uncomfortable emotional response when you see or think about a child nursing who can also walk, talk, ride a tricycle, and learn the ABCs.  This may be because we tend to judge what we don’t understand, what is not familiar to us.  I know I did.

            I clearly remember, several years before I had children when I knew nothing about breastfeeding, seeing a three year old walk up to her mother and ask to nurse.  I was horrified.  I whispered to my husband, “I will never nurse a child old enough to ask for it words!” 

            How wrong I was.

            But I had never seen a three year old nurse.  I didn’t understand that this is the norm in other parts of the world.  I didn’t realize that the milk itself, continues to benefit a child.  More importantly, I didn’t know then that breastfeeding isn’t just a feeding method, but a way to comfort, nurture, and connect with a child.  And I didn’t realize how important this is to some children.

            Because of a fear of being judged, of having one’s motives questioned, not simply by women who feel like I did, but by those in positions of power, nursing women in the United States tend to go underground after a while.  This perpetuates the invisibility of the relationship and can make it more challenging for some women to meet their children’s needs. 

            If you can’t possibly see yourself nursing your child beyond a certain age, try to remember that what’s right for you may not be right for someone else.  This, of course, works both ways.  Even if you feel strongly that nursing should continue for two years or more, everyone’s situation is different.  The point is, as mothers, we receive enough judgment in our society and really, what we all need is support from each other.           

            Remember, too, that your feelings may change over time.  I can’t recount how many women have told me how expectations and assumptions about nursing changed as their own nursing relationship evolved.  Yours might too, just as mine did.

 ?Read Tamara' Story:  A Change of Attitude

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