The trouble with breastfeeding

Comment for on James Akre’s book The Trouble with Breastfeeding

The trouble with Breastfeeding in Anglo post colonial societies is held in the first part of that word. BREAST – continues to be problematic. We purport to be scientific societies, yet we humans are not included in much everyday mammalian discussion e.g. a book marketed here in Australia, called the Complete Book of Mammals – had no mention of humans or pictures to help children understand our place in the scheme of things.

In Australian legislation, bovine mammary secretion (cows milk), is the only one which does not need a descriptor in front of it, on pacakaged commercial products. We buy cows milk and it is simply labelled MILK. We tend to call it ‘normal milk’. So James is right there about cultural perception.

Should we use the species to define the milk, or the container in which it comes; cows milk or udder milk, human milk or breast milk, bottle milk, formula milks, rice milk, oat milk, soy? Those milks which are derived from plants, are not milk – the fat, protein and calcium content are standardised to approximate cows milk. Scientifically we need better descriptors. Evidence based practise (EBP) needs better definitions of what we actually want to describe. Even the WHO ones are not that helpful when we are actually working with parents. In a society where human milk feeding is the cultural norm, breastfeeding is a ‘collective noun’ for skin to skin contact, unrestricted access to the breast and species specific nutrition, which leads to normal growth and development. It isn’t about maternal choice at all. Post modern Western societies need to define just what it is that we want for children and what it is that governments want from women in contributing to savings in beleagured health care systems. Mothers milk is an untapped national resource which a change of national perception might result in the economic savings and health benefits that have been researched by Australian researchers (Smith; Drane).

Evaporated milk was developed as a means of combating failure to thrive in school children, because at that time all infants were breast fed (USA 1850s). The nutritional model is still used by the medical profession, and can easily ignore it if medical emergencies occur. Skin to skin contact and unrestricted access to the breast are ignored. Medical doctors should initiate a diaglogue with their vetinarary doctors to develop greater understanding of survival outcomes in mammalian young. This is highly relevant in developing endangered species programs. Perception of the problem is a vital factor in finding the appropriate solution.

James was very diplomatic in encouraging those of us, who work with the less informed, to be kind to them whilst they ‘catch up’. And he is right, in the face to face situation. I never cease to be amazed at other health professionals who support EBP in their field of expertise, who instantly respond on a personal basis, when asked an ‘academic question’, rather than one related to their special topic. I asked an ophthalmologist (at a professional lecture) if infants who were fully formula fed from birth should be considered ‘at risk’ for compromised vision. Initially he said he didn’t know – then at the break I approached him again, querying the importance of Omega 3 and Omega 6 fatty acids present in human milk. He said that ‘some women like my wife need to use formula’. Over the past 25 years, variations of this have been a typical response.

We also have much to learn from traditional human practices – the first peoples of colonised countries. Anthropologist have a lot to elucidate for nurses, social workers and carers. Australian Aboriginals describe the Earth as Mother – everything we need comes from her. The land south of Perth, in Western Australia was inhabited by the Bibbulmun – a name interpreted to mean ‘land of many breasts’. This means the place of ‘many good places to get good food’. My Anglo perception made me think otherwise at first. Aboriginal reports of historical cultural activity do not mention how babies were fed – it was less that ‘ho hum commonplace’ it was the same as any other human body function – no mention. Even today, other health professionals tell me that Aborignals don’t have breastfeeding problems. I think this i not quite right – we ll have similar problems – but our perception of ‘a problem’ is very different.

I would recommend this book to all those who can see the value of a ‘sugar and vinegar’ approach to optimal child health through the invaluable environment of human milk feeding and breastfeeding. And as a reminder that we all tend to believe that we ‘know the right answer to the problem’ – but really we need more view points, more basic truths to solve a multifaceted problem.