Breastfeeding Through the Minefield

Updated 6/21

I have some (okay, a lot of) things I want to say about breastfeeding.  In the original version of this post, I said: "The best way I can think to express them is to borrow the conceptual framework Annette Kolodny uses in her powerful and influential 1980 essay, "Dancing Through the Minefield" because for me, trying to reach one year of exclusively breastfeeding with my daughter felt like I was attempting to navigate a large field that was full of hidden land mines that might detonate at any moment."  But after an interesting conversation on facebook about the undertones of antagonism this framing device might suggest, I've decided to modify it to better articulate what I mean.

Perhaps, rather than suggesting breastfeeding is like navigating a minefield, it is more accurate to say it can feel like traveling a path that already has some obstacles of its own, but which is made much more treacherous by hidden mines that are planted along it.  The mine image still resonates with me because, if one of these mines detonates on you, there is no way to predict how much it will derail your progress.  Depending on how negatively these obstacles and mines impacted you, you might decide to take another path even if you were initially committed to the breastfeeding path.

I want to explain what I know about this breastfeeding path, how I navigated it, and how I try to help other women do the same.  So I am going to do those things here, as directly and as best I can.  I am not going to address the specifics of why breastfeeding is beneficial for mom and baby-- neither in terms of nutrition or nurturing-- because a google search would be more productive toward those ends.  If you are interested in reading this post, please keep in mind that it takes for granted my basic attitudes about breastmilk and baby formula, which are these:  Breastmilk provides babies with precisely the nourishment they need.  Baby formula meets many of a baby's most fundamental nutritional needs, though it does not have all the nutritional benefits of breastmilk.

I believe that the best thing a woman can do to meet her breastfeeding goals is to familiarize herself with the breastfeeding path, its obstacles, and the mines she might encounter along it.  And I believe that people who want to help women reach their breastfeeding goals can best do this by helping them navigate these obstacles.  We can help moms overcome the obstacles, show moms what the mines are and where they are likely to be encountered, help moms to deactivate them, and avoid setting additional mines for moms to navigate around.  Before I elaborate a bit on those beliefs, I want to describe, in as concise a way as possible, what I recognize as some of the obstacles that seem to be inherent to the path as well as what are, in my opinion, the most common among the many land mines one might encounter on this path.

In this framework, it is helpful for me to think of the first three obstacles on the breastfeeding path as precisely that-- obstacles.  This is because they are not actively "set" by anyone, as the mines are, though they may be exacerbated by the mines.  These obstacles are some of the complications of breastfeeding itself, and most of them come at the beginning-- as if a woman has to climb a steep hill immediately upon starting on this path.

Obstacle: The demands breastfeeding puts upon a woman's body
Breastfeeding is physically draining, especially in those first few weeks when the baby is likely to nurse every 1-2 hours (sometimes for an hour or more at a time).  It depletes a woman's body unlike anything else she will ever do-- even more so than pregnancy.  It also requires that she wake up frequently in the night to feed, which interrupts her sleep, further exhausting her physically.  I'd wager to say every mother faces this obstacle, and how much it derails her depends on how much support she has.

Obstacle: The demands breastfeeding puts on a woman's time
Breastfeeding takes a long time.  When Nora was a newborn, I once calculated that I spent over 6 of the 24 hours in one day nursing her.  Even once the child gets older and spends less time nursing, the demands are significant.  Mothers who must rely on pumping breastmilk must also devote considerable time to that endeavor.  Again, I think every mother must grapple with this obstacle, and whether she can overcome it depends on how much freedom and/or flexibility she has with her time.

Obstacle: Breastfeeding complications
There are quite a few "naturally occuring" obstacles to breastfeeding which can affect baby and mom.  These include, but are not limited to: tongue tie, shallow latch, oversupply, undersupply, inverted nipples, nipple soreness, thrush, plugged ducts, mastitis, and milk blisters.  These obstacles are different for every woman, and some of them can pop up at any time.  But in general, how much information the mother has about them when they strike has a large impact on whether she can overcome them.

So that brings us to the mines a woman may encounter along the breastfeeding path, by which I mean social, medical, cultural, and political factors that interfere with a woman's ability to successfully breastfeed her child.  Some of these are set intentionally, and some unintentionally.  Some were set long in the past and some continue to be set today.  But they can all be damaging enough to cause a woman to choose a different path for feeding her child.

Mine: Misconceptions about what to expect from breastfeeding
Partly because Americans have relied heavily on formula in the past, there are many widespread misconceptions about how the breastfeeding relationship should develop and how breastfed infants should behave.  When this mine detonates, women might be told their milk did not come in soon enough, they are not producing enough milk, their child is not getting enough milk, their child is feeding too frequently, their child is not gaining enough weight, and so on, even if none of these things are true, simply because many people do not know what to expect.

Mine: Obstetric Practices
There are many obstetric practices that can help save the lives of women and babies in extreme cases but which also reduce a woman's chances of successfully breastfeeding her child.  These research findings are sometimes controversial, but there have been studies which show that induced labor, the administration of certain medications to the mother during birth, cesarean section, delay in the first opportunity to breastfeed, and separation of mothers and babies in the immediate postpartum period decrease a woman's chances for breastfeeding success.  Not all healthcare providers educate their patients about these risk factors, so many women agree to these procedures in less severe cases with no idea that they might impact their breastfeeding outcomes.  When this mine detonates, it can stack the cards against the mother from the beginning, making it more difficult for her to reach her breastfeeding goals in the long run.

Mine: Patriarchal attitudes about women's bodies
I'm happy to go into more detail on this in individual conversation, but in brief, I will simply say that it serves the goals of male-dominated structures of power to sexualize the female body.  The power of patriarchy is so strong in our country that men and women alike often think that baring the breast for the purpose of nursing is "inappropriate," "weird," "disgusting," "pornographic," etc, even though nursing seems to be the primary biological/evolutionary function of the breast.  When this mine detonates, it can make women feel ashamed about using their bodies to nourish their children in public but also within their own homes.  It can also cause them to stop breastfeeding before they are ready if they are told their child is "too old" to be at the breast.

Mine: The pushing of baby formula
The World Health Organization has established a code that formula manufacturers are supposed to follow, which forbids them from doing anything I would describe as "pushing" formula on women.  But they don't always follow it.  They're trying to sell baby formula, so they find ways to make it seem desirable to women.  There are other ways that formula is pushed on moms, too.  I've read about and spoken to mothers who suggest they have been coaxed against their wishes into giving formula by OBs, pediatricians, administrators of social programs, and family members.  The list goes on.  When this mine detonates, it can inhibit breastfeeding success by upsetting the mother's breastmilk supply, perpetuating misconceptions about breastfeeding, and making women feel like the only way they can properly nourish their child is by providing baby formula.

Mine: The "Breast is Best" Campaign and other attitudes that position mothers in a hierarchy
I would like to believe the "Breast is Best" phrase was supposed to be an easy-to-remember reminder that breastmilk has nutritional advantages baby formula does not.  I can see how that would be useful given that in years past, a lot of women were taught to believe their breastmilk was nutritionally insufficient.  But I think the inclusion of the word "best" in this phrase is highly problematic.  When people to go around saying "breast is best," they erase all the many complexities of the mother/child breastfeeding relationship.  "Breast is best" ignores the situations in which breastfeeding might not be best for the mother, and by implying that breastfeeding is always best, the slogan creates counterproductive competition between mothers.  By positioning women who breastfeed as those who give their children the "best," it implies that women who use formula in any capacity must be inferior as mothers because they are not giving their children the "best."  In my opinion, that's just plain wrong.  When this mine detonates, it alienates would-be breastfeeders from the very women who could help them improve their chances of breastfeeding success.

Mine: Judgemental breastfeeding advocates
Unfortunately, there are a lot of lactation consultants and breastfeeders who engage in active shaming of women who do not exclusively breastfeed and/or do not know as much as they do about breastfeeding.  This upsets me for a lot of reasons, but most fundamentally, it is upsetting because shaming the mothers ignores the fact that they are not responsible for all the mines I've described above.  Further, shaming others is not only wrong; it is also not the way to get anything positive accomplished.  When the shame mine detonates, it can make a woman who needed more help or information about breastfeeding feel like the people who are supposed to help her do not have her best interest at heart.  It can make her feel like she is being persecuted by "lactation nazis" who do not understand her struggles, who judge her as a bad mother based on this single factor, and/or who think they are superior mothers or people just because they were able to breastfeed more successfully.  I imagine the detonation of this mine is painful at the deepest level and can see why it would turn mothers away from the idea of breastfeeding entirely.  If a woman wants to breastfeed but is unable to do it for any variety of reasons, she likely experiences feelings of disappointment, frustration, sadness, guilt, and/or insecurity on her own.  So to have someone add insult to her injury, even when the mom tried her best with the information she had, would give her good reason to never want to speak to a "breastfeeding advocate" again.

Believe it or not, that is the nutshell version of what I have learned and figured out about breastfeeding since 2011.  As you might already realize, part of the reason I have access to all of this information is because my socioeconomic and educational backgrounds afford me privileges that the vast majority of Americans do not have.  Breastfeeding success rates among different demographics in our country demonstrate that, like most types of success in the US, certain people of privilege have a much easier time accessing the most useful information and making use of it.  I am, of course, happy to talk to people in more depth about any of these ideas on an individual basis.  But now that I've outlined some of the most common obstacles and mines women encounter in this path, I want to explain what I did to navigate around them and what I try to do to in helping other women do the same.  My hope, I guess, is that people will take what they can use from my experience to help them reach their own breastfeeding goals and/or help empower other women to meet theirs.

What I did to navigate the path
If you want to breastfeed your child, you increase your chances at success by educating yourself about this path before and after the birth of your child.  (As an introductory overview, I recommend Breastfeeding Made Simple: Seven Natural Laws for Nursing Mothers, and as a web resource, I recommend kellymom.com.) I made clear to family and friends from the start that I intended to exclusively breastfeed.  Continuing to learn about breastfeeding after Nora was born allowed me to maximize the luck that came my way and minimize the effects of the mines that detonated on me.  I accepted that I could not expect healthcare providers to give me good information all the time-- whether they are obstetricians, midwives, lactation consultants, or pediatricians-- and I ignored examples of "advice" I felt were ill-informed.  I found one woman I trust who values me as a person and has breastfed successfully, and leaned on her help and support.  My lifelong friend, Krista, also put me in touch with a whole network of women to answer my questions, which helped a lot.  But I found that having even just one woman who knew what I was up against, who treated me like a woman instead of a milk delivery vessel, and wanted me to succeed had a huge impact on my success.  She helped me learn to navigate the minefield for myself.

What I try to do to help other women navigate the path
In fact, Krista has been such a help to me that I largely follow her model of support when trying to help others reach their breastfeeding goals.  I try to let all my pregnant acquaintances know that I'm happy to share my breastfeeding experience and advice with them, and I hope I don't make them feel like I am pushing it.  When friends and family members reach out to me for more information, I explain what worked for me.  I try to pass along the information that was most useful to me about where to look for proper information and what to expect.  I encourage them to get in touch with me at any time if they're having trouble.  I hope to make clear that when they face these obstacles or any of these various mines detonate on them, and they begin experiencing breastfeeding complications, I will be there to share the information I know, help them find answers to questions I can't answer myself, and point them in the direction of additional help and resources when they need more experienced advice.  I also think it's important to tell them they don't have to follow all the "rules" of proper breastfeeding all the time, and I try to help them figure out which shortcuts might help make breastfeeding more sustainable given their particular struggles.  If you're looking for help with reaching your breastfeeding goals, please let me know.

In every conversation I have about breastfeeding, I try to keep the following things in mind-- because these are the things I wish some people had been more cognizant of when they have discussed it with me.
-Every woman has a right to choose whether to breastfeed, how much to breastfeed, and how long to breastfeed.  While I can encourage what I think are healthy choices by sharing what I know about the advantages of nursing, especially with those people who are closest to me, I do not have a right to try to push my values on anyone else.
-As such, I feel it is my job to help women meet their own breastfeeding goals, not the ones I might set for them.
-Breastfeeding can be very difficult, especially at first.  The more encouragement and support a woman gets, the more likely she is to get over that initial hump and into the zone where it is beneficial and rewarding for everyone involved.
-Mothers are not the ones responsible for any of the obstacles or mines I described above, so they are not to blame for the vast majority of factors that complicate breastfeeding attempts in this country.  I try to make sure they know it's not their fault when trouble arises.
-Practices that empower women help them and their babies.  Practices that disempower women, even if they are done under the auspices of "helping" the child, often end up failing to benefit the child in the end.   The better physical and emotional shape a woman is in, the better off her baby will be.
-Shaming women will not lead to an increase in breastfeeding rates.  It contributes to a mother's feelings of alienation, which decreases her likelihood to breastfeed successfully.
-Everyone experiences these obstacles and the detonation of the breastfeeding mines in different ways.  Only the mother attempting to navigate the path can decide when it would be best for her to choose another path, whether that might mean introducing baby formula or switching to entirely.  I have, instead, an obligation to support the women I know in their efforts to feed their children as best they can.  And sometimes that means reminding a mother that any amount of breastfeeding she is able to do is beneficial to her baby-- whether that is nursing for two sessions, two days, two weeks, two months, or two years.  At other times, it might mean reminding them that there are plenty of other ways to nurture infants.

So there you go.  Everything Liz has wanted to say about breastfeeding, in 3,000 words or less.  I recognize that my form of activism only really works on women who want to breastfeed already.  But I firmly believe that by empowering those women, we will make breastfeeding more appealing to other moms, too.  Learn about the path, the obstacles, and the mines so you can best navigate the journey.  Help other women do the same.  And do your best to avoid setting additional mines that may inhibit their progress.