Breastfeeding, the Mother in Charge

We have reached a tipping point. In less than a century, breastfeeding has become the exception rather than the rule -- a devastating trend to the health and well-being of large segments of the world population. Increasing the rates and duration of breastfeeding could save the lives of 1.4 million babies. It could also help national and local governments, in both developing and developed countries, to achieve the health-related United Nations Millennium Development Goals by 2015.

It is time to shed the dogma and take a fresh look at how breastfeeding can fit into our modern life. A culturally sensitive model needs to evolve where the mother is in charge of her body and fully engaged in her breastfeeding experience. Breastfeeding and life are not mutually exclusive: it is not about making choices, nor is it a science; it is about coaching and empowerment, not cheerleading. We need to take a look at the brilliance of formula marketing and steal their thunder. Controversy and romanticized depictions of a breastfeeding lifestyle have not inspired women to take up breastfeeding in lieu of formula feeding. What is needed is practical and empowering support for the mother so she can own her body and revel in the ability to nurture her baby.

Conscious Breastfeeding, a term that I have coined, embodies clinical observations and experiences supporting breastfeeding in a bottle-feeding, formula-centric culture. Although breastfeeding is natural, it is a learned skill: the mother needs to teach her baby to have a deep, comfortable latch. She needs to take full responsibility for the quality and ongoing optimization of her breastfeeding experience, which should absolutely not hurt.

Throughout the last half century, the prevailing misconception has been that babies are born knowing how to breastfeed. This may be true to some extent: they are instinct driven and their will to survive inspires them to keep alive by clinging to, and obtaining food from their mother. However, not every baby can figure out the intricacies of a great latch. The quality of a latch described as "good enough" may not be sustainable for a modern mother, or her doctor. Over the past three decades, my appreciation of this fact has evolved. The synchronicity between baby, breast and brain -- the hormonal circuit -- has always put the focus on the baby. The baby does drive the system but does not understand all the variables. Not every baby knows entirely what is best for them. They can either overfeed or underfeed, and when given such latitude, their rhythms of waking, sleeping and eating often cause them to become fretful and fussy.

Babies and breasts are not generic. You can be more stringent with a non-variable, less easily-digested food source, such as formula. Breastfeeding, by virtue of its variability in both definition and constitution, is therefore not something that can be easily standardized, unlike formula. To have any hope of a consistent approach and outcome, the focus needs to be on achieving an optimized latch so that maximum calories are delivered in a comfortable rhythm for both mother and child.

Ask someone to define breastfeeding and you will get many answers, which often cloud arguments both for and against the practice. Generalizations are made in breastfeeding management that cannot possibly include the majority with such a vague definition of what it means to breastfeed.

Who is in charge? The current party line is the baby. This flies in the face of reality and basic survival. Why would any baby willfully refuse food from the onset? They do not know their mother has "choices". Clearly unable to do anything on its own, a baby relies upon its mother for nurture. This includes, but is not limited to, breastfeeding.

Conscious breastfeeding mothers understand that the breast is a source of food for their baby. They feed with intention. They are fully engaged in each feeding. The loving arms of mother, father, family members and other caretakers will happily hold their babies between feedings. Unfortunately, there has been an insidious medicalization of breastfeeding over the past 25 years. Paediatricians and lactation consultants are micromanaging breastfeeding and focusing on external measures, rather than on the skill of breastfeeding. Promotion and support has begun to centre around achieving milestones associated with bottle feeding and formula.

The reason that breastfeeding rates are faltering has as much to do with the helpers as it does with the formula and drug companies producing human milk substitutes.

In highly industrialized developed countries, the pervasive use of pumps and bottles of breastmilk or formula have made it difficult to even accurately define breastfeeding.

Breastmilk has become a commodity. Purchasing human milk from a milk bank is very expensive and not a viable option for people in distressed economic situations. Formula comes in far cheaper.

Interrupting the synchronicity of baby and breast through over-reliance on mechanical pumping can have a negative impact on milk supply; it often leads to increased supplementation and early weaning. Worse yet, it distracts from the essence of breastfeeding, which is the connection of a mother with her child.

It is no longer possible to rely on the knowledge that breastfeeding is natural or to believe that the instinctual baby is the final arbiter of breastfeeding success. Babies are being born into a world where they and their mothers are faced with many artifacts and challenges to breastfeeding.

Breastfeeding needs to be understood from the inside out. Assumptions that there will be pain or lack of milk supply or inability to connect are not helpful. This is a recipe for shorter duration of breastfeeding, less brand loyalty to mother's milk and many mixed and conflicted feelings about the experience of breastfeeding.

Breastfeeding continues to work well in traditional cultures such as the Masai tribes of Tanzania. It is expected that all of Masai babies will be breastfed by their own mothers or someone else in their group. Regrettably, this is not the case for the majority of women throughout the world who view breastfeeding as a choice that operates under a medical model. They feel a need to justify the value and efficacy of breastfeeding against using formula. This paralysis of analysis erodes the confidence of these mothers by playing on their fears that preclude the development of a global positive breastfeeding culture.

Women have fought long and hard against being marginalized because of their hormones and sexual identity. Viewing the sovereignty of their breasts for nurturing their offspring has never gained the level of sexiness as has breaking the glass ceiling. Sadly, being freed of this biologic function is now seen as a righteous choice for many modern women.

A shift in focus to Conscious Breastfeeding could have a profound effect on long-range outcomes. It's all about the latch and fostering conscious connections. Focus should be on quality versus frequency, and on breastfeeding rather than gadgets.

When cultural anthropologists of the future look back on this moment in human history, what will they find? Will they see a tipping point in breastfeeding advocacy where we were able to successfully support and preserve breastfeeding?

Breastfeeding is not standardized, but it can be optimized in each mother-baby unit over time. The power needs to shift away from the baby and doctors and back to the mother. The veneer of breastfeeding support needs to be removed and replaced with an army of coaches teaching the skill of a deep quality latch.

Breastfeeding is the biologic norm, but it requires the conscious attention of the mother to be successful. Simply put, the mother needs to be empowered and put in charge of her own breastfeeding outcomes.