The US Infant Feeding Culture

When I started my lactation course, I tracked down some of the breastfeeding groups to follow on Facebook, figuring it might help me stay on top of new relevant studies and issues.   Earlier in the week I read these two blog post, are the Benefits of Breastfeeding Overstated and Shame, guilt and the search for common ground.  Both of these posts are powerful commentaries on infant feeding choices in the U.S., and were prompted by a recent breastfeeding study publication.  My goal in this post is not to discuss the study, but both of these posts spoke to something I’ve been grappling with for a while.  

How do we fully support women in breastfeeding without judging women who either do not want to, or cannot, breastfeed? 

The U.S. is in a cultural transition, an ambiguous phase where we are no longer a true formula feeding culture but neither are we a breastfeeding culture.  Breastfeeding has become powerful in public health rhetoric and policy, but our societal structure lags far behind in true breastfeeding support.  In fact, our society fails to support new families period, regardless of infant feeding method.  We are simply not a culture that values structural support for families; we are just a culture that likes to talk about it.

Breastfeeding is the biological norm, and in my opinion, a healthy society should hold it as the norm for infant feeding.  But this should not mean that formula is poison, or that feeding your baby formula makes you a bad mother.  Feeding decisions are not made in a vacuum.  There are many competing elements that influence what is the best choice for any given family.  Breastfeeding is one way to give your baby a healthy start, but it is not the only way.

Our culture is in transition, however, and our formula feeding biases are still strong and pervasive, as are breastfeeding rules dating back to a time when we knew far less about breastfeeding mother baby dyads.  Many people aren’t even aware of their infant feeding biases.  Uncovering bias and changing cultural norms are both uncomfortable processes.  Pushing public health policy without real societal change is a challenge, but how else to you start?  

Women are caught in the middle, being told to breastfeed but with little support or accurate information. Often time’s parents have no idea that the advice they are given, even from healthcare providers, is unintentionally undermining their breastfeeding goals.  No one wants to find out that the reason they could not breastfeed had nothing to do with their own biology and everything to do with a system that failed them.  

That system needs to change.  Biases and norms need to change.  Maybe we can’t fix all the factors that create barriers to breastfeeding or supporting families, but educating people, especially the healthcare system, is a big part of that process.  But change is uncomfortable and people get defensive.  That is true no matter the topic.  So, is it any wonder that infant feeding choices have become contentious?  

There are still too many breastfeeding barriers that are completely preventable.  These challenges can cause anyone to perceive problems, or in fact have problems, that would not have occurred with accurate information and appropriate support.  Although women of all socio-economic and education levels struggle with many of the same breastfeeding barriers, there is also a large breastfeeding disparity in the U.S.  Until preventable problems are tackled and there is breastfeeding equity, there is a need for advocacy surrounding breastfeeding.  

But what about women who can’t, or don’t want to, breastfeed.  Why does pushing society to make room for breastfeeding mean stigmatizing formula?  I don’t believe it has to do so. 

But for that to happen, we need to try and respect all feeding decisions.  We need to find ways to correct inaccurate information, without projecting judgment.  Parents need to be supported and informed so that whatever their feeding choice is, they can be confident in their decision.

Maybe I’m showing my bias by saying that I would love to see a culture where breastfeeding is assumed and supported, and if you are not breastfeeding, it is assumed that you had a very good reason not to do so. 

If you'd like to share your infant feeding experiences, or thoughts on our feeding culture please comment below!

Reflecting on Newborn Ian

As Ian’s first birthday approaches, I’ve been reflecting on our experiences since he was born. 

I remember the first few weeks after Ian was born.  We were tired, of course, but not as tired as we had expected.  We were enjoying getting to know our baby on the outside, and learning his little quirks and needs. 

I spent most of my time breastfeeding, and being waited on by my mom and Bennett.  Ian was held pretty much non-stop.  Holding him was relaxing for everyone, and I felt strongly that I needed that bonding time with him after missing out on the normal physiology of labor and immediate skin to skin (he was born via a caesarian because he was breach).  

Of course this was a time of adjustment and learning, but it was much easier than I thought it would be.  I expected to be tired, to dedicate most of my time to breastfeeding, to have a baby that needed to be held…so my perceptions of these activities were normal and manageable.  My theory is that this is because the reality of having a baby was pretty close to my expectations.  What was truly difficult, and still is, was his birth, where my expectations were so far from reality that I was left with a dissonance difficult to incorporate into my life narrative comfortably.

As a side note, I do know that I also had a very high level of support, and that this greatly contributed to my lack of baby related stress.

It would be interesting to study how first parent’s expectations of a baby match with the reality of the baby and how that relates to their stress levels.  From Facebook posts and conversations with mothers in my neighborhood, it seems like many parents have unrealistic (in my opinion) expectations of baby behavior, or have no idea what to expect.  Add in our culture’s belief that babies should be independent from a very young age, and that you can spoil an infant, (both points I disagree with) and parents are stuck struggling to fit their baby reality into our mainstream baby construct.  I believe this gap between expectation and reality is a source of stress, frustration, and self-doubt. 

During my practicum for my MPH, I observed a breastfeeding class in which the instructor taught a very excellent point that still sticks with me today.  In reference to holding a baby, she tried to get the class to look at it from the baby’s point of view.  When you are in utero, you are warm and held close and rocked all the time.  Then you are born.  If your family holds you even half the day, that’s still half as much as you are used to.  Many people refer to the first 3 months of a baby’s life as the 4^th trimester, acknowledging that birth should not mean an independent baby…but that’s a whole other post and I’m digressing. 

We need to do more to prepare expectant parents for the reality of a new born, with all the normal variations…to help them look at the world from the perspective of their baby…to try and teach them to read their baby’s individual needs…to help lesson that gap between expectation and reality…