The power of obstinacy
Elisabet Helsing Dr Med Sci
Keynote Address delivered at State of the Art of Mother Support Summit
(WABA/LLLI), 18–19 July 2007, Chicago.
Dedicated to Bìbi Vogel, Brazil and Argentina, founder of Amigas do Peito, † 3 April 2004.
Breastfeeding Review 2008; 16 (2): 5–7
Rather than expounding on the ‘power of breastfeeding’, the theme of La Leche League International’s 50th anniversary, I am going to act as the ‘Devil’s advocate’. I will instead argue that as a basic function, breastfeeding is surprisingly weak, and will remain so unless, and until, we women consciously and determinedly turn it into a force for supportive action and solidarity between ourselves, between women. I will also argue that this is more than a distant dream … it can be done and it has been done.
So, why do I describe breastfeeding as weak? As a natural act, breastfeeding is dependent on reflexes, both on the part of the mother and on the baby. Baby has relatively little trouble with its breastfeeding reflexes. Mother has more problems. Her reflexes are susceptible to negative, as well as positive, psychological stimuli. Take the reflex that is most central to breastfeeding, the ejection reflex; without it the baby will get very little of the milk that is actually present in the breast. The frailty of breastfeeding is partially due to misunderstanding and misinformation about the inherent ejection, or letdown reflex.
In fact, the baby does not suck the milk out, but is dependent upon the push of the letdown reflex to obtain the milk. But the letdown reflex itself is dependent on psychological stimuli. Therefore, breastfeeding may be easier for those mothers who have a psychology with a certain stubborn streak in their nature, for those who are not so easily discouraged, for the obstinate. When I breastfed a century ago, misunderstandings and misinformation were found everywhere in my country, Norway. Doubt was expressed about everything from frequency of feeding (Do you really think she is hungry so soon?) to the quality of the milk (Are you sure your milk is good enough, since she is hungry again so soon?). Humans are the only species with the ability to make verbal statements about psychological problems in the form of messages.
The main and most destructive message when it comes to lactation conveys precisely this: doubt. Doubt about our own ability to perform. I am reminded of a Jelliffism, after the famous couple Derrick and Patrice Jelliffe (1978) who stated that ‘breastfeeding is a confidence trick’. Confidence is the antidote to doubt.
A mother’s doubt about her ability to breastfeed may become a self-fulfilling prophecy. This doubt, in combination with poor or misleading advice, was central to the large-scale experiment that was initiated globally around 1900, when the milking machine, invented in 1895, made large-scale milk production possible. Then the milk destined for a small ruminant, the calf, was suddenly thought to be preferable as a basis for human baby food.
In the US, the breastfeeding rates sank faster than anywhere else: in 1911 58% of mothers were still breastfeeding their 12-month-old babies (Woodbury 1925). Yes, almost two thirds of US mothers were breastfeeding their one-year-old child in 1911. Fifty four years later, in 1965, 27% of the mothers were feeding at one week of age (Lawrence 1994). Yes, under one third of US mothers were even trying to feed their babies at the breast in 1965. Today, I believe, the percentage has increased to approximately 50%, that is, only half of the mothers have the courage to put the baby to the breast.
BREASTFEEDING REVIEW VOL 16 NO 2 2008
An unfortunate alliance between the producers of substitutes for human milk and special products for baby feeding, and the health sector in general has to take part of the blame. The health sector, quite certain of their independence from the industry and their innate ability to give correct advice, became part of a global misinformation campaign. In my home country, Norway, where we took part in this folly, statements made by the medical profession would typically read:
The infant should receive its meals at fixed and regular intervals and these should not be too short (Meyer 1899); The more strictly one adheres to the proper feeding times, the calmer and healthier the child will be (Brinchmann 1943).
And this: Once the doctor has set the times of the feeds and determined how much milk the baby needs, you must adhere strictly to his instructions and neither allow extra feeds nor alter the prescribed timing (Dahl 1964).
This philosophy was repeated on a global scale, in one country after the other, as a battle against the babies and their inborn reflexes developed. It is perhaps not so surprising that a study undertaken by the World Health Organization (WHO) (1981), in nine countries around the world during the late 1970’s, consistently found that the more frequently mothers got in touch with the health care system, the less they breastfed.
This finding was however buried on page 149 of the published report and it was never acted upon. It did not even ring a bell when another WHO study of nine countries, this time in Latin America one decade later, found exactly the same: the larger the percentage of births that were guided by health workers, the less mothers breastfed (Pérez-Escamilla 1993).
The physician’s fascination with the ‘modern’ way of feeding is perhaps understandable. It was the age of inventions; natural science had led to discoveries that were truly bordering on the miraculous. The power of steam had been harnessed and used, opening large tracts of land to new groups of people, and later, electricity had been invented, which turned day and night around and enabled active usage of more of the 24 hours of the day. The telegraph, the automobile and the aeroplane were allowing individual communication on an unprecedented scale.
And in medicine, miracles abounded too. Semmelweiss found the solution to the feared obstetric fever or puerperal fever, which killed so many mothers when they were giving birth. Pasteur substituted fanciful explanations of the communication of illnesses with science that could be acted upon. Vaccines and antibiotics became part of the armoury of the physicians. So who can blame the health sector for not drawing a line, but carrying their enthusiasm for all things man-made and medical over to the feeding of the very young? Why should calves’ food not be better for little humans, especially as it had been modified according to the latest science?
An American physician spoke of the entire development toward artificial feeding as comprising ‘not only a great scientific achievement in itself’. It also provided, as he put it, ‘the means of changing the whole trend of professional thought upon the subject and of establishing this science of infant feeding upon an exact and rational basis’ (Cumming 1858).
It may be tempting to condemn the medical profession for their behaviour. However, we should try to see their situation in light of the times as they were.
Let us go fast forward to Scandinavia of today. I have often been asked why breastfeeding has returned to the degree that it has, in the Scandinavian countries (see Figure 1). It would probably be wrong to classify half of the Scandinavian population as particularly stubborn and obstinate. Maybe it is possible instead to turn my argument on its head …
Much of the success story is accounted for by the (relative) absence of obstinacy on the part of the health care system, once the mothers started to protest the hundred-year experiment upon their babies by insisting to feed them their own milk. Politicians and health administrators in Scandinavia began to take breastfeeding seriously as a subject. Health workers with experience as mothers also played an important role. Gradually, the understanding emerged that breastfeeding is not just something that women automatically do when left to their own devices. Breastfeeding is a serious political subject, and taking it seriously costs money. Maternity benefits that extend to 12 months after the birth of the baby, reimbursed by the state so as not to act as a deterrent to employment of women, is going to cost the state money - big money. Likewise, the implementation of the Mother-Baby-Friendly hospital, and the creation of a scientifically sound basis for training of health workers, does not happen without state intervention. Female politicians and administrators are usually helpful, especially after they have nursed in Parliament. I do not for a moment imply that all is well in the states of Scandinavia. But we are on our way. And when large-scale political interventions happen, many happy mother-and-child couples are left in their wake. Breastfeeding is no longer just for the obstinate.
Brinchmann A 1943, Barnets første år. (Baby’s First Year). 5th edn. Gyldendal Norsk Forlag, Oslo. Cumming WH 1858, On a substitute for human milk. Am Med Monthly 9: 193–199. Dahl A 1964, Jeg er blitt mor. En håndbook til hjelp ved barnestell. (I Have Become a Mother. A Manual of Management). Det lille universitet, Fredhøis forlag A/S, Oslo (orig. Mondadori Western Publishing, Verona). Jelliffe DB, Jelliffe EFP 1978, Human Milk in the Modern World. Oxford University Press, Oxford. Lawrence RA 1994, Breastfeeding. A Guide for the Medical Profesion. 4th edn. Mosby, St Louis. Liestøl K, Rosenberg M, Walløe L 1988, Breast-feeding practice in Norway 1860-1984. J Biosoc Sci 20: 45.58.
� Meyer L 1899, Den første barnepleje. Populært fremstillet. (Nursing Your Baby). 3rd edn. Det Nordiske Forlag, København.
� Perez-Escamilla R 1993, Breastfeeding patterns in nine Latin American and Caribbean countries. Bulletin of PAHO 27(1): 23–42. Rosenberg M 1991, On the Relation Between Living Conditions and Variables Linked to Reproduction in Norway 1860-1984 [doktoravhandling]. University of Oslo, Oslo. Woodbury RM 1925, Causal Factors in Infant Mortality. Children’s Bureau Publication No. 142. US Government Printing Office, Washington. World Health Organization 1981, WHO Contemporary Patterns of Breastfeeding. Report on the WHO Collaborative Study on Breastfeeding. WHO, Geneva.
ABOUT THE AUTHOR:
Elisabet Helsing is a nutrition physiologist who has previously worked for WHO Regional Office for Europe (1984–96). She started the ‘back to breastfeeding’ movement in Norway when she wrote a pamphlet about breastfeeding in 1968. In this same year, she founded the breastfeeding mothers’ association Ammehjelpen, which celebrates its 40th anniversary this year. Elisabet has since written extensively about breastfeeding and her latest book Understanding Breastfeeding is currently being translated into English.
Correspondence to: Dr Elisabet Helsing
� Trosterudveien 19 N-0778 Oslo Norway Email: firstname.lastname@example.org © Australian Breastfeeding Association 2008
Tags: Bibi Vogel