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However, women remain unsupported in their selection to breastfeed, from work policies and a lack of timely data and support, to house attitudes and perceptions of a "good baby" as one which sleeps through the night and therefore requires slowly digested method to do so.
The conflict in the middle of the lactating and revered sexual breast in Western community means that while the media is awash with images of 'boobs', communal breastfeeding is taboo. A 2009 study found that 36 per cent of Australians said breastfeeding was unacceptable in a cafe or at work. Jennifer James of Rmit University, which conducted the study, said "Part of the issue why young mothers wean their babies too early is societal pressure and isolation from other mothers experiencing the same difficulties."
The effect is that many women do not build breastfeeding, the trauma of which is then compounded by the censure faced when bottle feeding.
In recognition of the experiences of these mothers, Christchurch based counsellor Karen Holmes, is launching a counselling aid specifically for "unvalidated grief" around women's breastfeeding experiences.
Holmes explains: "This is something which is just never talked about, but for many women giving up breastfeeding is a very real loss which impacts their lives. It may never be acknowledged as grief - not by others and not even by themselves." This grief therefore expresses itself in other ways, for example through anger at breastfeeding mothers or feelings of resentment at being let down by the health system.
Holmes offers counselling to those impacted by baby feeding grief, trauma or related concerns, along with mothers and those who find themselves with issues in their work with mothers. Counselling could be historical, for example with grandmothers, as well as for contemporary issues. In addition to grief from not establishing breastfeeding, it can also arise when a child weans unexpectedly.
Mother of three, Charlotte, comments: "I breastfed my eldest for 23 months. I couldn't breastfeed my middle son and I had to bottle feed, it caused me a lot of negative psychological stress for a while, and I got it into my head that he didn't love me. My third son I breastfed for just over 6 months, then he decided he wasn't concerned anymore and beloved food and a bottle. This was a bit of a shock at first."
Infant feeding issues may also arise in pregnancy. For example, one mother who had an eating disorder when younger, had recurring nightmares throughout her reproduction that she would be unable to feed her baby.
University of Albany evolutionary psychologist Gordon Gallup believes the grief a mother may feel also operates at the level of biology, commenting: "For most of human evolution the absence or early cessation of breastfeeding would have been occasioned by miscarriage, loss, or death of a child. We contend, therefore, that at the level of her basic biology a mother's decision to bottle feed unknowingly simulates child loss."
A study of 50 mothers conducted by Gallop showed that those who bottle fed scored significantly higher for postnatal depression than breastfeeders.
Feelings of loss at not breastfeeding may be compounded by guilt, and also rejection by having felt undermined by questions when attempts at breastfeeding were underway.
Holmes spent ten years as a La Leche League (Lll) leader and observed that much of the meetings were devoted to discussions about addressing challenges from others toward breastfeeding women. For example "are you sure you've got sufficient milk", "that baby's got you wrapped around it's wee finger", and assumptions about the period of breastfeeding and the need for supplementation from formula.
Anthropologist Sheila Kitzinger in Ourselves as Mothers (1992) stresses the importance of self-belief when she writes: "The firm expectation that (women from original cultures) will breastfeed successfully is much more prominent for a mother than any definite breastfeeding practices... Women can breastfeed under apparently impossible conditions if they are convinced that they will be able to do so."
Breast vs Bottle Polarisation
The polarisation of breast versus bottle hurts mothers and the women at the frontline of breastfeeding promotion. Holmes comments: "There appears to be this big agency in the middle of breast and bottle feeding, but there are multi-causal factors with baby feeding in Western culture today along with historical, cultural, familial and political. In a culture that often wants to point the finger in one direction, in reality it serves no one to do this. I believe we need an honest look at where we are to answer that the two camps have much in common."
Holmes continues: "I think we need to appreciate that all women go through the same ringer when development decisions about feeding their babies - a successfully breastfeeding mother could have had endless struggle, undermining and interference to get to that point, just like a method feeding mother. But yes, the breastfeeding mother's trauma may be alleviated by her eventual success."
Holmes herself experienced problems breastfeeding so knows first hand what women may go through. Holmes said she wanted to breastfeed her now grown-up daughter for economic reasons and because "it gave me an excuse to be close to my baby", a poignant testament to the independence thinkable, in the middle of mothers and infants in Western society.
During the first few days of her daughter's life, and having strangeness feeding, Holmes was "constantly questioned" as to either her baby was getting sufficient breastmilk and was "eventually worn down", and gave her baby formula. She then overheard man saying of her "they just don't try very hard these days do they". However Holmes persevered, and with help from an Lll breastfeeding counsellor regarding positioning of the baby, she went on to breastfeed until her daughter was three years old.
The breast versus bottle turn over has lead to an emphasis on breast pumps, by viewing breastfeeding through a bottle feeding lens and equating breastfeeding with breastmilk. However the use of breast pumps are related to a decrease in milk contribute and therefore negatively sway breastfeeding outcomes.
Carol Bartle, coordinator of the Canterbury Breastfeeding Advocacy Service, comments "Breast pump marketing implies that all women need a breast pump to breastfeed, and the only pressing issue is seeing out "which pump is right for you". However seductive the pump marketing messages are, with their impressions of the contemporary mother's need to get away from her baby, fathers' need to give bottles, and images of intriguing women with their backpack and pump, the reality of pumping is that of a complex and time intriguing institution that is hard to maintain. I have yet to meet a woman who enjoys pumping but have known hundreds who love to breastfeed once they have established breastfeeding".
Bartle, who has 30 years' feel working in neonatal oppressive care, where women try and build their milk supplies using breast pumps, continues: "Many pumps are inefficient and do not remove milk effectively sufficient to utter milk supply. Women who give breastmilk to their babies in bottles, and do not put their baby to the breast at all, are at the top risk of serious milk contribute problems."
This observation is confirmed by a 2009 study from Stanford University School of Medicine, California, which found that "pump suction alone often fails to remove a principal fraction of milk as more can be expressed using by hand techniques". So to ensure pumping is done effectively, and the milk contribute is maintained, pumping needs to be done in blend with hand massage techniques. Something few women are aware of.
Barriers to breastfeeding
It is very clear that women should not take sole responsibility for their breastfeeding experiences. Holmes identifies that grief issues "depend on self-image and expectations", so that when women are given unrealistic ideas of breastfeeding and at the same time undermined on the way to achieving breastfeeding, the grief and sense of failure can be significant.
New Zealand's National Breastfeeding Advisory Committee (Nbac) in its 2008-2012 national plan for breastfeeding detailed a list of 13 communal and environmental barriers to breastfeeding. These included the perception that artificial feeding enhances the father's opportunities to bond with the infant, attitudes that make breastfeeding embarrassing or uncomfortable for the woman, societal expectations about the standard period of breastfeeding, a culture that portrays bottle-feeding as normal, and returning to work, by selection or through financial necessity.
The World health organization (Who) says that "virtually all mothers can breastfeed, provided they have correct information, and the reserve of their family, the health care ideas and community at large".
These sentiments are reinforced by the pro-formula backlash, for example the book Bottle Babies by Adelia Ferguson (1998), which catalogues letters from bottle feeding mums - many of which are a testament to a basal lack of reserve around their breastfeeding experiences.
Holmes comments: "Many bottle feeding mums feel very traumatised by their persistent efforts to breastfeed to the point where they will not ever try again with subsequent babies. Sadly much of this feel is due to inaccurate breastfeeding information. However, there are successful breastfeeding experiences after some greatest circumstances. This is done knowing how breastfeeding works and that others have done it successfully."
In 2008, the Uk's Scientific Advisory Committee on nutrition said of the most recent baby Feeding study in 2005 that "The reasons mothers gave for abandoning breastfeeding advise that relatively few mothers truly chose not to breastfeed. Three-quarters of breastfeeding mothers... Said they would have beloved to breastfeed for longer had they been able. These findings advise that most women who start to breastfeed are committed to it but stop because they encounter problems and find that skilled reserve is not effortlessly available."
In recognition of this, the Canterbury Breastfeeding Advocacy aid provides not just data about breastfeeding but practical reserve in the form of networks in the middle of health care professionals, local groups and mothers. Bartle comments "We are trying to shift the culture to one that supports and protects breastfeeding women, rather than just promoting breastfeeding without reserve structures in place to really make a difference. For example, I have just been working with a mother who said that the most beneficial assistance she could have received while trying to build her preterm baby on the breast after going home from the hospital, was home help."
Meanwhile, commenting on the national situation in New Zealand, outgoing Lllnz Director Barbara Sturmfels, says: "Legislative changes to heighten conditions for breastfeeding mothers in the paid workforce, a communal advertising campaign to promote breastfeeding in public, and reserve for the implementation of Unicef's Baby cordial Initiative in New Zealand are some of the ways that the government is seeking improvements in breastfeeding rates through institutional and societal change."
Many problems need not prohibit breastfeeding were they seen as part of the breastfeeding journey and if consistent reserve and data were on hand in the crucial first days and weeks. Denise Digman in Breastfeeding in New Zealand: Practice, Problems and policy (1998), says the medicalisation of breastfeeding has detracted from "perceiving the range of bodily sensations and difficulties experienced while breastfeeding as part of the general spectrum of events". This is echoed by Nbac which talks of "insufficient knowledge about the general policy of breastfeeding, along with coarse problems and the solutions".
Holmes gives an example from her own life to explicate this point: "In her first weeks, my youngest daughter was putting on very wee weight and this was of concern to the Plunket nurse. I explored what factor might be creating the question and discovered a cowsmilk intolerance. As soon as this was eliminated from my diet her weight gain improved. Without this knowledge, this could have turned into a safety issue."
New Zealand's breastfeeding rates collate favorably with those of other industrialized nations. Distinct countries part the rates in Distinct ways and for Distinct years, but for a broad comparison, rates for exclusive breastfeeding are: New Zealand 2008 16% at 8 months; Canada 2008 14.4% at 6 months, Australia 2007 14% at 6 months, Usa 2006 13.6% at 6 months, Uk 2005 less than 1% at 6 months.
However seen globally, it is clear the impact Western values may have on breastfeeding. Who recommends that infants be exclusively breastfed for the first six months and for breastfeeding to continue "up to two years of age or beyond".
The top 5 countries for exclusive breastfeeding at 6 months (Unicef 2008) are Rwanda 88%, Kiribati 80%, Sri Lanka 76%, Solomon Islands 74%, and Peru 69%. At aged 20-23 months, Sri Lanka, Burkina Faso, Ethiopia, Bangladesh and Nepal all had breastfeeding rates of over 80%, with Nepal at 95%.
In New Zealand, rates for Maori and young mothers are much lower than average, and Maori currently have the lowest exclusive breastfeeding rates in the country. This is also a hallmark of Western society: As Glover et al explicate in Maori Women and Breasfeeding (2008) "Beliefs and practices introduced to Maori by European immigrants to New Zealand have replaced Maori baby feeding practices". The report therefore recommends that "promotion of breastfeeding to Maori should focus on re-establishing breastfeeding as a tikanga (right cultural practice)".
As well as Karen Holmes new counselling service, Christchurch is fortunate in having the Young Parents' Breastfeeding Group Whangai U "Matua Puhou". Headed by communal health advocate and breastfeeding peer counselling administrator Susan Procter, the group has over 20 quarterly members and meets ordinarily to reserve breastfeeding families where the mother is aged under 25.
Procter comments: "The impact the group has had is enormous, both in terms of breastfeeding success and also in giving any of the mums a passion and motivation to apply to enter the health care professions to advocate for breastfeeding and to reserve other young mothers."
Breastfeeding as Patriarchy
A further irony of the breastfeeding turn over is that when a mother does successfully breastfeed, she is likely to be censured if she continues past an arbitrary cut off point of a few weeks or months.
Part of the question is that motherhood, the archetypal female domain, is accused of becoming a patriarchy with male values overlaid upon it. For example the reverence of science over instinct, of experts over the mother's voice, and of consumer products over the mother's body. This is particularly relevant with the medicalisation of birth, with the rising number of cesarean sections impacting negatively on the preparing of breastfeeding.
Dr Truby King is a controversial example of the mothers' expert, having founded New Zealand's Plunket community in 1907 "to help the mothers and save the babies" and the Karitane product community (Kps) in 1927, which consolidated King's production of baby formula.
Linda Bryder says of King in A Voice for Mothers (2003) "The analysis of the question and the solutions put transmit were the same everywhere: mothers were ignorant of the correct methods of child-rearing and needed to be educated". Meanwhile Sheila Kitzinger claims that King "Destroyed women's reliance in breastfeeding and made loving mothers feel inadequate and guilty."
One hundred years later, that fee was still being leveled at Plunket for the promotion of scheduled feeding, based on the digestion time required for formula, rather than for speedily digested breastmilk. The emphasis has shifted recently with Plunket advising that "your baby may wake wanting frequent feeds. For breastfed babies these feeds are prominent to help build and utter breastfeeding". However the organisation remains out of step with international Who guidelines by recommending breastfeeding only "until they are at least 1 year or older".
Plunket's controversial partnering of breastfeeding promotion with corporate interest through King's method production, continues today with Wattie's sponsorship of Plunket. Wattie's promotes Nurturebaby method and markets "Stage 1" baby foods for "4-6 months onwards", in conflict with Who's suggestion of "exclusive breastfeeding for 6 months" and Plunket's suggestion of "breastfeeding exclusively until around 6 months". The Plunket logo appears on the containers of Wattie's Stage 1 foods, giving the perception that Plunket endorses feeding solids at 4 months, despite the clear conflict with Plunket's own policy. The presence of the Plunket logo also gives the impression that Plunket is endorsing that singular brand of baby foods above both competing brands and baby food prepared at home.
The patriarchal inheritance remains a tangible presence for women, their partners and families today. Holmes comments: "Progressively, women were told that their instincts, their feelings and all else they may have previously believed were wrong and they needed to listen only to the experts if they wanted their babies to live. This creates internal conflicts which may become problematic, especially the thought that something must be wrong with a woman as mother."
Holmes continues "It is with this that I want to work, for example validating grief, feelings, impacts. Helping women to understand what creates these conflicts and giving them permission to feel what they feel. I would hope also that in doing this women may secure a sense of their own wisdom and feel empowered to make informed choices."
Holmes stresses that the understanding and reserve of fathers is a crucial part of this process. Holmes comments: "Breastfeeding is a human issue, not a women's issue. Men have a principal and active role in supporting women to breastfeed and in protecting it." This is reinforced by Sturmfels who says "Informed and skilful mother-to-mother reserve can really make a difference. A new mum needs the love and reserve of her partner and family."
Holmes concludes: "What is most prominent is that all mothers are honored in their experiences around baby feeding. That mothers feel supported, valued and safe bet in their own potential as a mother."
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