Welcome to Motherhood: The Early Days and Weeks
Barbara L. Behrmann
New York USA
From NEW BEGINNINGS, Vol. 25, No. 2, 2008, pp. 4-9
Editor's Note: This article and the accompanying stories are adapted from, The Breastfeeding Café, a book based on personal reflections from breastfeeding mothers. While the book covers the full range of the breastfeeding experience, the focus here centers around the first days and weeks of nursing when most mothers are greenhorns to the world of babies, breasts, and milk. It speaks to how a woman’s ability to get breastfeeding off to a good start is influenced by the kind of birth experience she has, the early advice and support she receives, and the involvement of health care providers.
Initiation into this new world of motherhood involves a roller coaster of emotions: everything from delirious joy and love to overwhelming exhaustion and confusion. For some, nursing just "clicks." For others it doesn't and the pleasures of breastfeeding may seem a long way off. For most women, though, the fog does life, as does our sense of being lost.
With a strong support system in place, we are better able to navigate through the early days of motherhood, whether that system includes seeking help from a knowledgeable health care professional, gathering with other moms, or attending La Leche League meetings. One of the benefits of connecting with other moms is that we share our stories. We learn that we are not alone, we gain perspective, and we can see our joys and struggles reflected in each others' lives. And it helps us to realize that many of the challenges we face are not simply private problems, but have their roots in our culture and society.
Early Obstacles and The Birthing-Breastfeeding Connection
Studies confirm that when we are offered reliable information from health care providers, we are more likely to initiate breastfeeding and keep it going (Cadwell 2002). Unfortunately, medical support for breastfeeding doesn't necessarily mean that women receive consistent and reliable information. Although some obstetricians, pediatricians, and family physicians provide wonderful information and support, publications that address breastfeeding have often been filled with misinformation and bias, and medical and nursing students fail to receive the knowledge, training, and experience they need to properly counsel breastfeeding mothers (Dettwyler 1995).
But access to information and support is only part of the picture since breastfeeding challenges can begin before babies even take their first breath. Many women talk about being treated as a machine, rather than as a thinking, feeling woman with a capable body. This can undermine a woman's confidence in her body's ability to nourish a child, creating a double emotional whammy of sorts. Paula, for example, a mother in Pennsylvania, USA, says, "I lost a lot of confidence in myself because of my birth experience and my inability to process it." She reflects, "I didn't know I had the right to follow my instincts and demand the kind of birth I had envisioned. I felt I had failed at the birth, so to fail at breastfeeding was devastating."
Moreover, research shows that common obstetrical practices, including medical, technological, and surgical interventions, can adversely impact breastfeeding (Kroeger 2004). Linda Smith, a lactation consultant and well-known lecturer on this topic, notes, for example, that all drugs used to manage labor pains are documented to affect the baby's breathing, sucking, and/or muscle tone. "It's a wonder why any of these kids can suck at all, much less properly," she declares. And the more drugs the mother gets, the more the baby gets, and the more likely its ability to breathe, suck, and swallow will be affected (Smith 1996). Moreover, internationally renowned midwife Ina May Gaskin points out that using drugs to avoid pain during labor can often lead to pain after the birth. And the less comfortable a mother is, the more difficult it is for her to focus on the needs of her baby.
After-the-birth factors continue to impede a woman's ability to nurse. In many hospitals around the US, medical staff separate mothers and newborns shortly after birth to weigh, measure, and clean the baby. In fact, as documented in a 1990 study published in the medical journal The Lancet, staff often whisk babies away at about the same time the infants would begin searching for the breast on their own if left undisturbed -- 15 to 20 minutes after birth (Righard and Alade 1990). The authors add that there is "no sensible reason" for this routine separation and that the procedures could easily be postponed.
The obstacles women face in developing a joyful breastfeeding relationship are structural and wide reaching. Yet without an understanding of the bigger picture -- and when intellectual reasoning is replaced by sleep deprivation and hormonal upheaval -- it is easy for a woman to think she is at fault. Even those of who read about breastfeeding ahead of time tend to rely on the particular advice from health care providers. And too often women are steered in the wrong direction.
Breastfeeding does not have to begin as a set of problems to overcome. Nursing can evolve harmoniously, organically, and holistically. Although this can be the case for women regardless of where they give birth, women who have their babies at independent birth centers or at home are more likely to get nursing off to a good start. This is not surprising. Women in these environments are less likely to be given drugs or be subjected to unnecessary, invasive procedures, both of which can interfere with nursing. They are also more likely to be supported and respected during labor and delivery and less likely to be separated from their babies. It is perhaps no coincidence that the primary health care providers in both of these settings tend to be midwives who view birth as a normal, natural, and healthy process and whose mission is, in part, to support breastfeeding.
Having a baby at a birth center is an option that facilitates early and successful breastfeeding. As of April 2008, there are 195 birth centers in the US, and their numbers have been increasing, albeit slowly (explains Kate Bauer, executive director of the National Association of Childbearing Centers, personal communication, 2008). The birth center philosophy is in sync with the midwifery model of care and offers a safe alternative for healthy women with normal pregnancies. Vikki, a mom from New York, USA, gave birth at a free-standing birth center and was home fewer than 12 hours later. In her story, "Relating Primally," she reflects on the commonalties humans share with all creatures who nurse their young. (Editor's note: "Relating Primally" appears as "Relating as Animals" in The Breastfeeding Café.)
As a pregnant woman, I felt, for the most part, quite powerful. For the first time in my life, my breasts were sources of life. How I loved that period of time -- the anticipation; the space to have philosophical, broad thoughts; not yet caught up in the minute-to-minute exercise of mothering. Breastfeeding was never an intellectual choice for me. It was just the most basic, primal, animal way to be. We were fortunate to have supportive midwives whose entire philosophy and technique are that the baby is given the chance to be on your belly, at your breasts, immediately after birth. Beginning breastfeeding was not problematic. My "sticky-out" nipples, of which I was never particularly fond, were well suited for latching on -- which is just what Lily did. She was one of those babies who cried ferociously out of the womb and kept crying while lying on my belly, near my breasts. Then, after she calmed down, she discovered my nipples, latched on, and that was that.
Early on we were able to breastfeed lying down so I could be as rested as possible, even doze a bit while she fed. I needed a lot of pillows for support but soon could breastfeed anywhere, even walking around. When I nursed Lily it just seemed right. When she was very tiny, her limbs not yet fattened up, she felt like a newborn monkey, grasping my body, nuzzling my neck when I held her upright, clinging like any tiny infant on any big mama animal. When it worked best, we did not relate as human to human, but as animals. I remember what it felt like lying on my side, Lily suckling at my breast flopped against the bed. This was often time for golden, tender connection. But I also would grow antsy. Convinced she'd had enough, I would pop her mouth off with my pinky and roll away, conscious of my desire to be comfortable. She'd cry, I'd try to comfort her, she'd breastfeed again, and the cycle would begin anew.
Though breastfeeding was easy, I hit one snag when Lily was about three months old. A part of my breast became increasingly tender. It turned out I had a blocked duct, threatening infection. I was spending a week with a friend, so we went to see her midwife, a vibrant, maternal, British-accented grandmother. Another animal scene. She had me position myself on all fours, my breasts hanging like an udder above Lily's face, and breastfeed there in her office. I was sent home with instructions to orient myself this way so Lily would suck at a certain angle to the blocked duct and basically suck it open. The midwife also suggested two homeopathic potions, plus going to bed with my baby. Lily and I ended breastfeeding a little over a year ago. She was 17 months old, and I was ready to stop. Now, at two and a half, our connection seems stronger, more real. Perhaps it is because early on in our relationship I had to learn how to slow down and take care of her and myself.
Avoiding Common Breastfeeding Problems
Many women who happily nurse for months, if not years, find that the glow of early motherhood is merely a reflection of the night-light burning at 3 am as they frantically try to figure out what they are doing wrong. While a certain degree of insecurity and angst is to be expected, however, some women endure more. Sore nipples, engorgement, nipple-confused babies, and seemingly not enough milk are all common hurdles that, with proper support and information from the beginning, could be easily ameliorated, if not prevented.
In addition to the technical information that makes things so much easier, good lactation support provides a picture of what is the normal course of breastfeeding -- as well as the assurance that we are doing a good job and can overcome the difficulties that arise.
Along with the impact of birthing practices on breastfeeding, women are often encouraged to breastfeed while applying the principles of bottle-feeding. We may be told, for example, to restrict the number of feedings, feed for short periods of time, encourage nighttime weaning, and offer supplemental bottles of formula. Such advice may create a chain reaction of difficulties. Consider how the common problem of insufficient milk typically develops, for example.
The more milk a baby removes from the breast, the more milk a woman produces. When we attempt to nurse at specified intervals, for shorter durations, or offer supplemental bottles of formula, babies suckle less, so our breasts produce less milk. Our babies then become hungry, and we conclude that we don't have enough milk. Voilá! "Insufficient Milk Syndrome," a major reason for premature weaning. As lactation consultant Marsha Walker, IBCLC, explains, "Most of it comes from poor breastfeeding management from the start and a poor understanding of a breastfeeding baby's behavior" (personal communication, 1996).
Of course, not all women experience these problems. But the prevalence with which situations like these occur speaks to the degree to which medical mismanagement of breastfeeding contributes to the cultural context of new motherhood. In cultures where breastfeeding is still the norm, where one only has to look to one's mother, sister, or neighbor for advice, women may be less vulnerable to medical opinions. In the United States, though, too many women lack this personal connection to other breastfeeding mothers. And where bottle-feeding remains the norm and the focus is on the birth of a baby and not on the birth of a mother, mothers are often left on their own to wander through the wilderness of new motherhood.
It is perhaps not surprising, then, that Cindy Turner-Maffei, national coordinator of Baby Friendly USA, an organization that implements UNICEF's Baby Friendly Hospital Initiative in the United States, points out that the majority of breastfeeding stories we hear tend to center around pain, inadequacy, or embarrassment, hardly themes that make breastfeeding seem desirable (Turner-Maffei 2002). But to pretend that nursing comes easily to all of us does a similar disservice. As Jennifer, a new mother, wrote: "Where were the stories that could have prepared me for this ordeal? Everyone had told me their labor stories, so I knew my labor, while difficult, was 'normal.' But my friends hadn't told me their nursing troubles because they said if I knew how hard it could be sometimes, I'd never have tried. Yet more stories would have kept me from feeling so alone in my journey."
In "My Little Barracuda," the author emphasizes the need for good postpartum support, both in the hospital or birth center and after a mother is back home. Ann describes several weeks of nursing problems until a lactation consultant showed her how to position her baby at the breast. A technical adjustment was all she needed.
My Little Barracuda
My oldest child came into the world kicking and screaming, welcomed by two parents who couldn't have been more happy to see her. After checking her fingers and toes, I looked at the nurse and said, "What do I do now?" She informed me that we were going to breastfeed. "We are?" I said in disbelief. My daughter latched on with little assistance, and the nurse gave me the thumbs-up. "You two make a perfect team!" she gushed. I was so proud -- obviously it was due to the classes I had taken prenatally. I became confident and secure. Then came the fourth feeding in the early hours of the morning. I was alone in my hospital bed, and my darling daughter wanted to be fed. Ouch! When had she grown teeth? No one said that it would hurt like this! In fact, I distinctly remember them telling me that if it hurt at all I was doing it wrong! My confidence was withering on the proverbial vine. I have no clear memory of the eight weeks that followed. Snippets appear like a bad dream. I reached out to many different people and publications and received as many different answers as I asked for. According to THE WOMANLY ART OF BREASTFEEDING, my daughter was labeled a "barracuda." But barracudas have teeth -- sharp ones. I recall the public health nurse calling to check up on me. She scared me when I admitted to having a blister and a crack. "You'll get mastitis if you're not careful," she warned. My husband watched supportively as I cringed and curled my toes while latching her on to my damaged nipple.
I called the lactation consultant at the hospital where my daughter was born. I was convinced she was the only adult woman in the world who hadn't heard my tale of woe. She told me I needed to see her immediately, and I began to cry with relief when she offered to help me firsthand. I packed up the baby, my two-ton diaper bag (since she was my first baby I needed to carry everything I owned with me), and my fatigued postpartum body and headed back to the hospital in the cold Minnesota January. I broke into a sweat under my heavy winter coat as I toted all my accoutrements back to the hospital nursery and got plenty of strange looks from passersby. My paranoid, sleep-deprived mind was convinced they were whispering: "Look! She's returning her baby. What a shame."
Somehow I made it to the lactation consultant's office. I took off layer upon layer and had the consultant, literally, stuff my breast in my daughter's mouth. It didn't hurt. What? It didn't hurt! This was great! All I had to do now was heal the wound on my left nipple and learn a slightly different "attack" from that described in the books. I found that "sandwiching" my nipple with a finger above and below the areola instead of on each side allowed me to get more of it in her mouth. I was home free! I sat in front of a bare light bulb three times a day to heal that nipple. I wore nipple shields to allow air to the sore area. I went to lengths that astound me now, and I have no idea where my resolve or stamina came from. But ultimately my daughter and I went on to nurse successfully and blissfully for 12 more months.
Since then I've had two more daughters and nursed them for nearly 17 months each. My nipples got sore, but I found that going braless to allow air to circulate around the sore nipple helped facilitate healing before any real damage occurred. This, coupled with the latch-on technique I learned from the lactation consultant, helped me to avoid serious problems. Breastfeeding is the most natural way to feed your baby? Most certainly -- but it's important to attach the words, "It doesn't always come naturally."
Support Helps Breastfeeding
Although many women consider breastfeeding -- or not being able to breastfeed -- one of the most significant experiences of their lives, it remains one of the most misunderstood, devalued, and invisible aspects of mothering. Some cultures simply are not comfortable with breastfeeding. In ways both big and small, overt and subtle, some societies discourage nursing and undermine a woman's ability to develop a satisfying nursing relationship with her children.
Mothers need support, validation, and a window into the day-to-day realities of what it means to nurse in a culture where bottle-feeding is the norm. Many women face similar situations -- lack of support and appreciation for the ongoing work of nurturing children, and a lack of public understanding that breastfeeding involves more than nutrition, immunology, and health. Breastfeeding is also about comfort, security, and connection. And it matters not just to babies, but to mothers, too.
Women must begin to talk about breastfeeding honestly and unabashedly. We need to shatter the myths surrounding it and insist on the right to nurse our children without apology and with dignity. In a time in which pregnancy, childbirth, and child rearing are subject to increasingly sophisticated technology and ever-ready "expert" advice, women have the power to be each other's greatest support systems and allies. We can provide each other with wisdom, insight, and inspiration and validate and reinforce each other in the myriad choices we make for our lives.
Simply put, there is power in mother-to-mother support and storytelling. Your story deserves to be heard.
Cadwell, K. Reclaiming Breastfeeding for the United States: Protection, Promotion, and Support. Boston, MA: Jones and Bartlett Publishers, 2002.
Dettwyler, K.A. Beauty and the Breast. In Stuart-Macadam and Dettwyler (eds.), Breastfeeding: Biocultural Perspectives, 1995.
Gaskin, I.M. Ina May's Guide to Childbirth. New York: Bantam Books, 2003.
Kroeger, M. and Smith, J. Impact of Birthing Practices on Breastfeeding: Protecting the Mother and Baby Continuum. Boston, MA: Jones and Bartlett, 2004.
Righard, L. and Alada, M.O. Effect of delivery room routines on success of first breast-feed. Lancet 1990; 336:1105-7.
Smith, L. Why Johnny Can't Suck? Available at http://www.bflrc.com.
Article adapted and reprinted with permission from The Breastfeeding Café, copyright Barbara Behrmann, 2008. Published by University of Michigan Press.
Writing Your Own Breastfeeding Story
by Kathleen Whitfield
Something that can help mothers work through a not-so-pleasant birth experience or difficulties in the early days of breastfeeding is to write it down.
Although I didn't sit down to chronicle the early days of my children's lives, I've realized that I did so indirectly. I sent emails to friends and family that described what was happening. I got their support when I felt frustrated.
Now, years after their births, I remember the general emotions and the "highlights." I don't necessarily remember the small details of the early days of breastfeeding. I do have -- through my email "outbox" or by the archives of the email lists I belonged to -- a record of the details. Looking through them jogs my memory.
Looking back also offers perspective. If I were to write about my experiences now, they wouldn't have the raw power they did when the memories were fresh. Now, I can remember my frustration with -- for example -- bad advice I received, but I can also see how I overcame it.
Barbara Behrmann's Breastfeeding Café offers many of the emotions of the struggles and joys of breastfeeding in their rawest form. As with the "Mothers' Stories" section in NEW BEGINNINGS, which oftentimes describe the early days of breastfeeding when the memories are fresh, the stories pack an emotional wallop. Even if mothers can't identify specifically with the experiences, all of us can identify with the emotional vulnerability of having just given birth.
When we write our stories, we are able to remember that time all the more vividly. If you would like to share your experiences with the readers of NEW BEGINNINGS, submit your story by following these instructions [contact information edited for website]