Hi, readers of Crunchy Domestic Goddess. My name is Hannah and I blog at A Mother in Israel about life with my six kids, parenting, and homemaking, along with social commentary about life in Israel. I also volunteer as a breastfeeding counselor. Last week I attended a conference with breastfeeding expert Diane Wiessinger. You can read my introductory post here.
Israel, aside from being a center of international conflict, is a developed country of seven million with a high birth rate. A lactation consultant told me that in her town of 30,000, enough children are born to fill six kindergarten classes every month.
In Israel breastfeeding is the default option, at least in theory. You don’t hear much about the choice to breast or bottlefeed, and mothers are expected to nurse in the hospital. But hospital routines are rigid, and in some cases babies still sleep in the nursery at night–with the mother needing to request a wake-up call that may or may not happen. Babies often get one or more bottles in the hospital. Outside of hospitals formula companies promote their products freely, even though Israel is a signatory to the WHO Code of Marketing Substitutes.
Israeli mothers receive 14 weeks of paid maternity leave, up from 12 thanks to a recent law. Fathers can replace mothers at home after the first six weeks. Mothers also get a “nursing hour,” working one hour less daily, for an additional four months and in some cases up to a year of age. (Bottle-feeding mothers get it too.) La Leche League and other volunteer organizations are active, and the number of IBCLCs (International Board Certified Lactation Consultants) has grown exponentially, but medical professionals lack knowledge and most mothers don’t make it past a few weeks or months.
A few years ago, several babies died because one type of imported soy formula lacked Vitamin B1. This caused a temporary upswing in breastfeeding rates. Unlike in the US, nursing in public is barely an issue.
One of Wiessinger’s talks is called, “Watch Your Language.” When discussing the talk with friends, I found that moms get defensive when they hear about the risks of bottle-feeding. But by exploring the connection between language and breastfeeding, we don’t mean to chastise mothers for giving formula. Mothers are subject to many pressures and make decisions that work for their families. Mothers who wean early are the last ones we should blame.
We need to change the way our culture looks at breastfeeding. The breastfeeding rates of the United States and Israel are behind those of other western countries. Since babies and mothers are fundamentally the same, the problem must lie in the culture.
In her talk Wiessinger showed how the language used to talk about breastfeeding ultimately harms mothers and babies. We use imprecise language because we are afraid: Afraid of making something considered average and normal (formula feeding) look bad, and of making mothers feel guilty. In the end, this fear prevents parents from getting accurate information.
Wiessinger began by asking: If you could choose only one of the following ways to feed your baby, what would you choose?
- Bottlefeed, but with your milk (no cheating with a nursing supplementer), or
- Breastfeed your baby your own way, but with formula coming out of your breasts.
Wiessinger said there is no right answer, but she would choose the latter because the breastfeeding relationship is most important to her. I think she meant to say that formula is not evil.
Wiessinger believes that every loving mother does, by definition, the best balancing act she can. It’s not necessarily best for her baby, but best for her corner of the world. With information and support, how she balances her needs with those of the baby will change. It’s reasonable that sometimes breastfeeding doesn’t work out, but this should not be because of lack of information and support.
We talk about “benefits,” “better,” and “special.” Breastfeeding has no benefits, it is not special nor is it the best. It is the biological norm and what babies expect and need.
Her first example of how the media distorts breastfeeding was the headline: Study finds link between breastfeeding and cancer, about a study that showed an increase in cancer rates among formula-feeding mothers. Breastfeeding is always in the news, not formula and bottles.
Wiessinger, whose background is in animal behavior, explained how scientific experiments are set up. The norm is the control group, and the experimental group, the group getting the drug or treatment, is the focus of the study. But with formula, the control group–breastfeeding– becomes the focus of inquiry. The experiment–formula feeding–should be the focus of research and concern.
Health summaries usually link problem outcomes to problem behavior, with the control understood to be neutral or safe. Consider the “Surgeon General’s Encouragement:” Clean air during pregnancy may result in a bigger, healthier baby born closer to due date. In this satiric example, the negative outcome has not been linked to to the problematic behavior.
In a parenting magazine a pediatrician responds to a mother of a baby with nine ear infections, assuring her that the baby is healthy and the infections are normal. No one tells the mother that breastfeeding would likely have prevented many of these infections, so she is unlikely to breastfeed her next baby. Time Magazine wrote that low levels of lead cause a dramatic drop in IQ of 7.5 points. Not breastfeeding causes a 7-8 point drop in IQ in many studies, yet no one seems concerned.
Talking about a reduction in rates of illness among breastfed babies makes formula-feeding the norm. To reverse the language, researchers will need to change their approach. Wiessinger believes that once the researchers get it right, the media will too. And if the risks of formula appear in the media, no one individual or mother is targeted.
A risk-based message insists that the public accept that something well-intentioned mothers do every day is causing harm to children. Breastfeeding helpers should leave promotion to others. We are there to help in a specific situation–let the mother learn about the risks elsewhere. Behind the scenes, we can push researchers and media to report accurately.
Here is Diane Wiessinger’s Modest Proposal, Part I:
- Remember what normal is.
- Insist on accurate reporting.
- With mothers, take a kinder, gentle route, but without losing momentum.
- Breastfeeding ensures normal, good health for baby.
- Breastmilk is the human baby’s normal food.
- Talk about the importance of breastfeeding, not the benefits.
- Let’s not idealize breastfeeding.
Boost mothers along, assume that they have already decided to breastfeed, and don’t hand them excuses in advance, like the FDA does in this article. (Scroll down to “Possible Problems.”)
Wiessinger listed terms that interfere with the idea of breastfeeding as normal:
- “Special.” Something special, like a wedding or holiday, takes a lot of work to prepare but you’re glad when it’s over. Breastfeeding isn’t special, it’s normal.
- BUT. It stands for, “Behold unvarnished truth.” For example: “It’s the mother’s decision, but breastfeeding is very important.” Instead of the pediatrician saying, “Breastfeeding’s best, but it’s not easy,” the phrasing should be reversed.
- Still. Would you tell an older person, “It’s great that you’re still driving?” Asking a mother if she is still breastfeeding implies that nursing has outlived its normal life expectancy. Instead, model the next stage by telling her about the good stuff up ahead.
- Extended breastfeeding is judgmental, while full-term breastfeeding is more accurate.
- Guilt is not all bad. It motivates us to get up in the morning. Women are good at guilt. But guilt implies a failure to sacrifice oneself, and breastfeeding is one of life’s greatest pleasures. The health profession cheats mothers by letting guilt distract us from linking problems to problem behavior. With other problem behaviors such as overeating, tanning, and inactivity, health professionals share facts with empathy and sensitivity. Mothers who didn’t breastfeed because of lack of information and support should feel anger instead of guilt. They should feel sadness, wistfulness, anguish, and regret.
- Committed to breastfeeding implies the possibility of failure. Is a woman with an asthma attack committed to breathing? Women know that they can wean, and we readily answer questions about it. But we don’t need to suggest weaning at the start.
- Let implies a power differential.
Breastfeeding promoters have several advantages over formula marketers.
- We can use humor.We joke about things that are part of our lives. Formula ads can’t be funny, because they have to stay within the approval of the healthcare profession. Wiessinger showed examples of successful humorous breastfeeding ads. One pictures breasts with the caption, “Fast food outlets: Two convenient locations.”
- Formula companies can only talk about their product and compare it to breastmilk. We get to talk about the breastfeeding relationship.
- The correct form of research, which puts the risks of formula feeding in the spotlight, is on our side.
- Formula companies talk about the product, not the process. We have to focus on the process, and put the norm into our own thinking.
- Insist on the right norm in publications. Breastfeeding is a normal process, not a perfect product.
- Normal is what we say it is. That’s why language matters. Normal is what everyone does.
- Normal is funny.
We mothers are grateful to Amy and others who blog about important societal issues like birth and breastfeeding, and I thank her for hosting me today. In the meantime, take Diane Wiessinger’s advice and Watch Your Buts.