By Stephanie Ondrack
Issue 137, July/August 2006
It took a few months of mulling the topic over in the back of my mind before I came up with some reasons. The evidence is soft, even circumstantial, but I think it all adds up. And I concluded that even Vancouver, British Columbia, Canada, with its progressive left-coast attitudes, embodies the traits of a bottle-feeding society. In some cases, this is only because we belong to a larger community. But still, if the bottle fits... The incidences of bottle homage are often subtle enough that we do not see them. They operate as a sort of smokescreen. Although doctors, nurses, mothers, and even formula marketers endlessly drone that "breast is best," they have not succeeded in surmounting the societal perception that the bottle is nonetheless okay, that it is really almost as good—indeed, that it is still the social norm. This normalization of the bottle takes place on a variety of levels and through a variety of media. Formula ads trumpet the putative benefits of artificial milk ("closer than ever to breastmilk"), but the real message—that bottle-feeding is the norm—is conveyed through less visible forms of representation. And while the media are discreet and the offenses hard to pinpoint, the message is presented persuasively enough that the many studies proving that breastfeeding is essential for normal human health and that formula can be harmful do not speak as loudly as the cultural cajolings that whisper to parents that bottle-feeding is just fine: Go ahead, you were bottle-fed, and you turned out alright.
Most revealing to me was discovering the depth of my own misconceptions. When my first baby was born and a nurse squeezed colostrum out of my nipple for the first time to encourage the baby to latch on, my jaw dropped in astonishment when I saw that my milk was exuded from not one hole, but many. I knew nothing about this. I'd read books on breastfeeding, taken prenatal classes, and my mother and all my friends had breastfed their babies, but I had always pictured the human nipple as having a single central hole—just like a bottle. That I could have known so little about my own body was possible only in a society in which the bottle has taken precedence over the breast. Such fundamental ignorance can hinder the understanding of breastfeeding even among the most keen—as it did for me.
Perhaps most elusive is the bias embedded in the word breastmilk itself. How did it happen that human milk is denied the propriety of the generic term milk? How did the milk of cows, a completely different species, achieve the honor—and the branding advantage—of milk? Did the dairy board exert its influence? To me, it seems downright suspicious that the word breast be thus highlighted. Where else would milk come from? By definition, all mammals lactate—the root word of mammal is the Latin word mamma, or breast—and possess mammaries for that purpose. We don't include the word breast when we speak of how goats, chimpanzees, bats, or whales feed their young. By calling human milk breastmilk, we draw unnecessary attention to the milk's means of conveyance.
Or, rather, we expose a cultural obsession with the human female breast as sexual object that has almost eclipsed its primary and original role as an organ of nutrition. If we were to restore to human milk its rightful term of just plain milk (and downgrade what we buy in cartons to cow's milk), we might be a step closer to ending the perception that there is anything sexual about a breast while it is nursing a baby, and a step closer to normalizing the way babies are meant to be fed.
It has also been well documented that we use an inverted language to describe the differences between breastfeeding and bottle-feeding. Breastfeeding is the biological norm; instead of talking about "the benefits of breastfeeding," we should be talking about the hazards or risks of failing to breastfeed. Breastfeeding does not increase a child's IQ per se—it is more accurate to say that the absence of breastfeeding prevents mental development from reaching its inherent potential.1 Human milk continues to nourish, develop, and hone a baby's systems postpartum, just as the placenta did before birth. From this biological perspective, babies expect to be breastfed, and will not achieve their normal projected potential if denied it. When we think of formula as "just fine" and breastmilk as "enhanced," we confuse the norm of tens of thousands of years with a technological convenience less than a century old.
Baby-shower paraphernalia—wrapping paper, gift bags, decorated streamers, cards, e-cards—is lousy with images of baby bottles. Since I began to notice this, I have been hard-pressed to find baby-shower items that are not abundantly festooned with bottles. Amid the heaps of shower bric-a-brac, not a single image of a breast is to be found.
When I was pregnant with my second child, I flipped through what must have been every sibling-preparation book in print, from classics such as Russell Hoban and Lillian Hoban's A Baby Sister for Frances to flashy, photo-filled board books such as My New Baby, by Annie Kubler. At first I rejected any book that contained images of baby bottles, but I soon realized that that would mean rejecting virtually all of them. So I thought I'd compromise on books that at least included breastfeeding—an image, a nod, a mention, anything.
Not so easy to find. I did manage to track down some children's books that actually promote breastfeeding, but I had to really search, and, in one case, special-order one from the International Childbirth Education Association (ICEA). (See sidebar, "We Like to Nurse.") It was important to me to normalize breastfeeding for my then-three-year-old, and to protect her from oblique overexposure to bottle-feeding so early in her life. I knew this was ultimately impossible, but I wanted to at least lay down for her a foundation of comfort and custom with feeding infants the way I was feeding mine.
I encountered the same challenge when I tried to buy my elder daughter a baby doll in preparation for her sister's birth—so many dolls are sold with bottles. This association between baby dolls and baby bottles is very strong. At my daughter's preschool, they learn to sing a song about putting a baby to bed that the teacher acts out with a baby doll. In the middle of the song, the baby starts crying and the children are supposed to suggest ways of soothing it. The teacher tries each one as it is called out: she gives the baby a teddy bear, wraps it in a blanket, and, invariably, gives it milk. Finally, the baby drifts off to sleep. The exercise is supposed to be about building empathy: the children must imagine the baby's needs and strive to fill them. But the teacher never puts the doll to her breast. Every time, she tilts a toy bottle to its mouth.
The same preschool has an impressive library of educational books that are used to teach children basic words. These include photographs of objects familiar to little kids, such as grapes, blocks, and bathtubs, accompanied by the word for each. One image found in every one of these books is of a baby bottle. Even a cloth book designed for the very youngest readers, with only a single large picture per page, devotes one of its four pages to an image of a baby bottle. No human breast appears in any of these books. From all of this published evidence, one would have to assume that bottle-feeding is the norm.
That breastfeeding a child in public is even an issue is one of the most telling examples of the supremacy of bottle-feeding. When breastfeeding a baby in public is equated with indecency, the message is loud and clear: Feed baby a bottle or stay home. This attitude promotes bottle-feeding while discouraging breastfeeding, forcing the breastfeeding baby and mother into the proverbial closet.
Breastfeeding is covered extensively in the media, but usually to make the point that it is being inflicted on too mature a child. In a recent episode of the television series ER, when a mother was about to breastfeed her school-age son, the doctors reacted by smirking in an amused but clearly aghast kind of way.2 We share a collective "gross-out" when we picture a prepubescent son lifting his mother's shirt for a quick num-num before he rides off on his two-wheeler. We hear people say, "As soon as a child is old enough to ask for it, that child is too old." Or, "After six months/one year/two years/[insert arbitrary cutoff age], breastfeeding is a selfish act to satisfy the mother's own needs." There is a general sense that, past a certain age, there is something wrong, something inappropriate and verging on taboo, about contact between a child and its mother's breast. But even if we have a firm sense of what age is, indeed, too old for breastfeeding, do we really think that prolonging a nurturing behavior past the norm du jour is equivalent to child abuse? Whom does it harm? We seem to make more of a fuss when someone breastfeeds past four years than when someone inflicts physical injury on a child, which usually elicits a disapproving but nonetheless respectful "How they raise their child is their business." Those of us who have nursed our babies into toddlerhood or beyond instinctively kept this ritual discreet. I never suffered a critical comment or dirty look, but as my daughter grew from passive recipient to active participant in the nursing relationship, I could feel the approving smiles of strangers gradually become awkward, averted gazes.
Bolstering this attitude is the unfounded belief that breastfeeding is beneficial only during the first three months, six months, year, two years, or whatever age is currently deemed old enough. But human milk does not suddenly become void of nutrition on the baby's six-month or two-year birthday. It is still just as nutritious, still provides immunities, and, most obviously, breastfeeding still provides immense comfort to the nursling. But we have been conditioned to undervalue a baby's need for comfort.
A hierarchy of needs
"She wasn't really hungry, she was just comfort-nursing." "He was just using me as a human pacifier." You've probably heard such phrases used to justify a parent's decision to night-wean or to stop or avoid breastfeeding in some way. We seem to believe that the only legitimate excuse for breastfeeding is hunger, and that anything else is a misuse of the goods. The term human pacifier is especially revealing—what is a pacifier but a plastic substitute for the breast? Similarly, we seem to regard as suspect any need of the breast a baby might have that is not strictly caloric.
The chemical composition of human milk has an opiate-like effect; it induces sleep. So it should come as no surprise that when they want to go to sleep, babies seek the breast.3 However, nature's plan causes our society anxiety. We feel we cannot indulge a baby's need when it involves anything other than nourishment, and that by doing so we will spoil the baby, teaching her that she needs the breast to fall asleep. We therefore deny the child this simple need and teach her to instead cry herself to sleep. Otherwise, there is a lingering concern that she will never learn to sleep without the breast.
But if babies cannot feed, walk, dress, or speak for themselves, why do we think they should be able to fall asleep by themselves? And just as babies outgrow diapers, crawling, babbling, and all other age-appropriate behaviors, they also outgrow breastfeeding and learn to sleep without the breast. I suspect that we fail to appreciate all that breastfeeding offers because bottle-feeding cannot even begin to provide these things. Babies come to the breast for much more than mere food. Breastfeeding affects cranial decompression,4 reduces the risk of cancer,5 prevents allergies,6 develops the jaw and brain,7 eases the baby's bonding with the mother8—and, yes, provides comfort. But we see the need for comfort as not only inferior to the need for food, but as requiring suppression. Our understanding of infants' nursing needs is skewed by the dominant bottle-feeding mentality.
Assumptions based on the formula model
When I was a first-time mom with a new baby, the community health nurses who ran my local drop-in group for parents and babies promised that we could not spoil our babies with too much attention. They heartily encouraged us to respond to all of baby's cries, explaining that it would lay a foundation of trust and compassion. However, this approach ceased to apply at night. Then, we were fiercely advised to ignore our wailing infants after they had reached some arbitrary age or weight, when they were supposed to be able to sleep through the night without parental comfort. Indeed, we were told that at this point babies suddenly had no need for nourishment for as long as 12 hours, but were simply crying to get attention. The responsible parent, we were told, would nip this manipulative habit in the bud, making baby forgo nighttime comfort cold-turkey. Babies should learn to comfort themselves, we were told. We should not permit them to make use of the breast for flimsy or selfish reasons. If they're not hungry, they don't need it.
Years later, I searched for any evidence that babies of a certain age or weight do not need calories at night. I never found any. My guess is that the myth that babies should not need to night-nurse is based on the formula model. Formula is poorly digested by the human infant,9 and formula is really only about the food. Artificially fed babies may indeed outgrow the need for bottles in the night at an early age, but I doubt they outgrow the need for parental comfort any more than they outgrow the need for the ideal nutrition that only the breast can provide.
When I teach breastfeeding positions in class, expectant parents often begin by holding their dolls in a cradle position, with the doll's tummy facing the sky, as a baby would be held for bottle-feeding. This does not work so well for breastfeeding—the baby's head would have to be turned hard to one side to make contact with the breast. But because images of bottle-feeding still predominate in movies, TV, and books, the bottle-feeding position has become the default definition of feeding position.
Another example of the formula model being misapplied to breastfeeding is when doctors advise mothers to stop nursing their sick babies and to instead feed them Pedialyte, an oral electrolyte solution used for rehydrating a baby after diarrhea or vomiting (basically, sugar, sodium, water, and artificial flavors). This would be correct medical advice for a formula-fed baby, but is rarely useful for a breastfed baby.10 A mother's milk responds to the pathogens in her and the baby's environment to adapt to the baby's specific immunological needs. This is why, with rare exceptions, its mother's milk is a baby's best medicine. Introducing a foreign substance such as Pedialyte into the gut of a breastfed baby who has the flu is usually foolish and unnecessary. But medical professionals often dole out such advice as if formula and breastmilk were interchangeable.
I suspect that this oversight applies to the rigid "10 percent rule" that hospitals here in Vancouver apply to postpartum weight loss in infants. Hospital-born babies are weighed immediately after birth, and are then expected to lose up to 10 percent of their body weight in the three or four days until the mother's milk comes in, before beginning to gain it back. If a baby loses more than this 10 percent, supplementation with formula is pushed mercilessly. In my experience, hospital staff don't spend extra time assessing baby's latch or position at the breast, nor do they suggest that the mother try nursing more often; they simply push formula. The problem of how a mother's milk supply can be adversely affected by supplemental bottle feeding11 does not seem to be raised.
Here in British Columbia, homebirth is part of the public healthcare system; it is carefully regulated, and midwives are required to keep records. The midwife weighs the baby at birth, then not again until one week later (unless there is specific cause for concern), by which time most babies have again approached their birth weight.12 Whether, in the interim, the baby has lost 1 percent, 10 percent, or 15 percent of the birth weight is never known. Instead, babies are evaluated for other signs of wellness versus dehydration, such as urine and feces output, good latch and position, energy level, and alertness.
As far as I can tell, the 10 percent weight-loss limit is based on nothing more scientific than hospital comfort levels. Babies are well equipped with fat cells to sustain them during their postpartum weight loss, until the mother's milk comes in and they begin to gain it back.13 How much weight is lost during that period is highly individual.14 The important thing is not the number on the scale, but that the baby has unrestricted access to the breast and is getting enough milk. There is no known harm to a baby losing, say, 10 percent of birth weight, but there is much known harm in giving a newborn formula,15 especially during the crucial first few days immediately following birth, when the foundation for the baby's immune system is being laid by the mother's colostrum. Yet we are so strongly attached to the "usualness" of babies being fed with bottles that we commit a well-documented risk to avoid an unsubstantiated one.
The recommendation by the American Association of Pediatrics (AAP) and the Canadian Paediatric Society (CPS) to exclude infants from mothers' beds betrays the same sort of misconception.16 It is important to remember that these organizations at one time advised against breastfeeding because it was deemed to be less "scientific" than formula bottle-feeding. The dismissal of the biological norm of breastfeeding requires the same sort of willful blindness as does rejecting the biological norm of cosleeping.
Imagine a mother gorilla or orangutan placing her newborn on a separate pile of leaves, to spend the night away from her baby. Or a mother in a nonindustrial culture leaving her baby to sleep all alone. All mammals sleep with their babies, and among the many reasons for this, ease of breastfeeding is no doubt paramount. Mammals nurse at close intervals throughout the 24-hour cycle of a day.17-19 As someone who, before she discovered the soporific bliss of cosleeping, tried getting up in the night many times to feed a baby, I can tell you that solitary sleep can be dangerously threatening to the breastfeeding relationship. Sore nipples were nothing compared to the exhaustion of getting out of bed every few hours all night long. When I finally let myself sink fully into the attachment of parenting day and night, I discovered, as have so many other mothers, that we all got a lot more sleep.
To believe that a newborn is safer sleeping alone than with its mother, or that a breastfeeding mother gets more sleep with her newborn out of arm's reach, is to deviate sharply from our biologically appropriate habits as mammals. Formula bottle-feeding is a deviation at least as severe. Because cosleeping supports and facilitates breastfeeding, not bottle-feeding, it is not surprising that our culture discourages this loving and normal mammalian practice. The rejection of cosleeping by so-called experts is yet more evidence that our collective parental instincts have been undermined by the norm of bottle-feeding.
When should I introduce the bottle?
Even families who are committed to breastfeeding are prone to unknowingly undermine their success by giving a baby the occasional bottle. In all my classes, people ask at what age they can safely start giving baby a bottle—something they seem to assume is inevitable. This is because fathers suffering from "breast envy" feel a need to join the exclusive feeding relationship of mother and child, because our culture values giving mother a break more than it values adjusting both parents' expectations to ensure that the baby's needs are met during the "in-arms" period, and because we are so conditioned to assuming that babyhood involves bottle-feeding that we "naturally" think it the next thing to do.
In Canada, working mothers get a paid parental leave of one year. Except for the self-employed and those who weren't working enough hours to qualify for paid leave, most Canadian mothers are not obliged to return to work until a baby is old enough to prefer a cup to a bottle. But we are strongly influenced by the notion that we must introduce the bottle, and soon, or the baby may never take one. We seem willing to risk nipple confusion,20 a baby's preference for the bottle over the breast,21 a threatened milk supply, colic, premature weaning, and worse, just so mom can go out for coffee without baby once or twice. We seem to have concluded that pumping breastmilk, buying and sterilizing bottles, and storing and reheating milk is easier or cheaper than simply committing ourselves to exclusive breastfeeding. We don't question our belief that all these extra activities—especially pumping, which is no picnic—somehow give mom a break. We believe all this because our cultural baseline is bottle-feeding.
Although it's unlikely these days that any layperson, let alone a health professional, would directly state that formula is healthier than breastmilk, we still collude in a culture that promotes bottle-feeding as "normal." As long as images of breastfeeding are overshadowed by images of bottles, and as long as formula-feeding facts are misapplied to the breastfed baby, breastfeeding will continue to be seen as a luxury rather than as the obvious best choice for babies.
1. M. Morrow-Tlucak et al., "Breastfeeding and Cognitive Development in the First 2 Years of Life," Soc Sci Med 26, no. 6 (1988): 635-639.
2. John E. Gallagher, II, Director, "If Not Now," ER, Season 12, Episode 256.
3. J. Cubero et al., "The Circadian Rhythm of Tryptophan in Breast Milk Affects the Rhythms of 6-Sulfatoxymelatonin and Sleep in Newborns," Neuro Endocrinol Lett 26, no. 6 (December 2005): 657-661.
4. Dr. Noel Stimson, DDS, "Build Dental Health with Breastfeeding," Mothering, no.130 (May-June 2005): 55-61.
5. Mary Renfrew et al., Bestfeeding: Getting Breastfeeding Right for You (Berkeley, CA: Celestial Arts, 1990): 5-6.
6. Health Canada Policy Statement, "Exclusive Breastfeeding Duration: 2004 Health Canada Recommendation," Health Canada: Infant Nutrition no. 4824 (2004).
7. See Note 4.
8. Marvin S. Eiger et al., The Complete Book of Breastfeeding (New York: Workman Publishing, 1987): 27-28.
9. Kathleen Huggins, RN, MS, The Nursing Mother's Companion: Fourth Revised Edition (Boston: Harvard Common Press, 1999): 2-4, 39.
10. La Leche League International, The Womanly Art of Breastfeeding (New York: Plume Books, 1991): 326-328.
11. Linda J. Smith, BSE, FACCE, IBCLC, "Keeping Up-to-Date: How Mother's Milk Is Made," Leaven 37, no. 3 (June-July 2001): 54-55.
12. Dr. William Sears, "Getting Enough Milk," Breastfeeding: www.askdrsears.com.
13. Dr. Jack Newman et al., Dr. Jack Newman's Guide to Breastfeeding (Toronto, ON: Harper-Collins, 2003).
14. Dr. Jay Gordon and Cheryl Taylor White, CBE, "Look at the Baby, Not the Scale," "Breastfeeding" (2001): www.drjaygordon.com/development/bf/scales.asp.
15. Marsha Walker, RN, IBCLC, "Just One Bottle Won't Hurt—Or Will It?" "Breastfeeding" (2005): www.drjaygordon.com/development/bf/supplement.asp.
16. J. McKenna, "Cultural Influences on Infant and Childhood Sleep Biology and the Science That Studies It: Toward a More Inclusive Paradigm," in Sleep and Breathing in Children: A Developmental Approach, J. Loughlin et al., eds. (New York: Marcell Dakker, 2000): 199-230.
17. J. McKenna et al., "Bedsharing Promotes Breastfeeding," Pediatrics 100, no. 2 (August 1997): 214-219.
18. S. Mosko et al., "Parent-Infant Co-Sleeping: The Appropriate Context for the Study of Infant Sleep and Implications for Sudden Infant Death Syndrome (SIDS) Research," Journal of Behavioral Medicine 16, no. 6 (December 1993): 589-610.
19. See Note 10: 106.
20. Jack Newman, MD, "How to Know a Health Professional Is Not Supportive of Breastfeeding," Handout 18 (January 2005): www.bflrc.com/new man/breastfeeding/mdnosupt.htm.
21. Jack Newman, MD, "Breastfeeding—Starting Out Right," Handout 1 (January 2005): www.breastfeedingonline.com/1.html.
Stephanie Ondrack is a childbirth educator and doula with the Lower Mainland Childbearing Society of Vancouver, British Columbia, Canada. Her older daughter, Reve, self-weaned before her third birthday, just in time for her sister, Choral, to be born and take her own rightful place at the breast.