Breast intentions

The strength and ubiquity of the “breast is best” message means there is greater awareness than ever of the benefits of breastfeeding: a public health message seen increasingly in terms of the risks of formula feeding. However, women remain unsupported in their choice to breastfeed, from work policies and a lack of timely information and support, to family attitudes and perceptions of a “good baby” as one which sleeps through the night and therefore requires slowly digested formula to do so.

The conflict between the lactating and revered sexual breast in Western society means that while the media is awash with images of “boobs”, public 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 result is that many women do not establish breastfeeding, the trauma of which is then compounded by the censure faced when bottle feeding.

In recognition of the experiences of these mothers, counsellor Karen Holmes, is launching a counselling service in Christchurch, New Zealand, 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.”

University of Albany evolutionary psychologist Gordon Gallup believes the grief a mother may experience 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.

Breast v bottle polarisation

The polarisation of breast versus bottle undermines mothers and those at the frontline of breastfeeding promotion. Holmes comments: “I think we need to appreciate that all women go through the same ringer when making decisions about feeding their babies. A successfully breastfeeding mother could have had endless struggle and interference to get to that point, just like a formula feeding mother. But the breastfeeding mother's trauma may be alleviated by her eventual success.”

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 towards breastfeeding women. For example “are you sure you've got enough milk” and assumptions about the need for supplementation with formula.

The breast versus bottle debate has also lead to an emphasis on breast pumps, by equating breastfeeding with breastmilk. However the use of breast pumps are linked to a decrease in milk supply and negatively affect breastfeeding outcomes.

Carol Bartle, coordinator of the Canterbury Breastfeeding Advocacy Service (CBAS) in Christchurch, comments “Breast pump marketing implies that all women need a breast pump to breastfeed, however the reality of pumping is that of a complex and time consuming practice that is hard to maintain.”

Bartle, who has 30 years' experience working in neonatal intensive care, where women try and establish their milk supplies using breast pumps, continues: “Many pumps are inefficient and do not remove milk effectively enough to maintain 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 highest risk."