Will I be able to breastfeed?” I asked Dr Neil Pattison at National Women’s Hospital, when I first learnt that my rhesus-affected baby would be born prematurely. “We hope that you will” was the welcome reply. And so began my foray into a surreal world of breast pumps, Lact-Aids and naso-gastric tubes. The exhilaration of producing the “liquid gold” of colostrum was neatly negated by the miserable experience of engorgement – “concrete balloon” describes all but the pain of the experience.
A long antenatal stay in hospital had given me ample opportunity to study the research literature on the composition and activity of human milk and to be reminded that breasts, despite the distorted sexual fantasies of advertising executives, define the class of vertebrates we belong to, rather than the brand of car we drive. We’re mammals, we feed our young. I’d even learnt the rather revolting fact that human breast milk is more akin to rats’ milk than that of most other mammals.
However, what convinced me most to put up with the mortification of daily attachment to “Murray” the milking machine, and a host of other indignities, was learning that, like blood and semen, breast milk was a “living” substance, not just a food, and the body naturally adjusts its composition to meet changing circumstances. Amazingly, the fat content in my breast milk would be higher to compensate for my baby’s prematurity. In hot weather, breast milk has a higher water content and when babies are of an age to be picking things up and putting them in their mouths, there’s a protective boost of antibodies. I was hooked on the nature – a million years of evolution can’t be wrong – and the science of breastfeeding.
But knowing why and what to do did not help me know how to do it. Expressing to keep up a supply of milk to tubefeed the baby was one thing – and after four prem babies I grew to love “Murray” for the time and effort it saved me – but breastfeeding was another matter. Forget rich men going to heaven and camels passing through the eyes of needles and imagine instead the minuscule mouth of a tiny baby feeding from what my husband unkindly described as a “mountain of mammary”. That’s when I turned to the mother-to-mother help offered by La Leche League (LLL) and learnt, in the words of their cornerstone publication, “The Womanly Art of Breastfeeding”.
Memories of those experiences came flooding back when I recently attended the conference celebrating 40 years of LLL in New Zealand. From small beginnings in the 60s, when the odd group of mothers got together to exchange tips for breastfeeding success, the voluntary organisation has established a nationwide network of meetings and telephone counselling support for parents* who choose to breastfeed. It’s a stakeholder in the New Zealand Breastfeeding Authority responsible for developing the Baby Friendly Hospital Initiative, and produces and disseminates a wide range of literature for parents and professionals.
The latter is critical, not only for offering the sort of practical day-to-day advice needed through all stages of parenting, but also to access current scientific research, information and comment. Among LLL’s many useful publications, the 700-page Breastfeeding Answer Book is a comprehensive guide to breastfeeding problems, encompassing the expert advice of practitioners – mothers and health professionals.
It’s a valuable resource for those who, like Dr Michael Wah, work in communities outside the mainstream. His large Asian clientele in Ponsonby would “never dream of seeking mother-to-mother advice over that of a professional. Asians prefer things neatly packaged where they can check the ingredients! Perhaps that is why they have such a low rate of breastfeeding. Though,” he adds ruefully, “on such matters, even the professional ranks way below the mother-in-law.”
By contrast, Pacific peoples prefer the community approach. Their high rates of breastfeeding (and low rates of post-natal depression) are largely attributed to the fact that they never lost the art of breastfeeding. In large families where successful breastfeeding is the norm, girls have plenty of opportunity to observe and learn the subtle techniques that make breastfeeding “natural”.
Such is not the case for Maori, where the low rate of breastfeeding promises a continuation of their over-representation in statistics for a myriad of breastfeeding-preventable conditions, from glue ear to eczema. It’s ironic that the strong women’s networks in Maori communities have not seen breastfeeding as a priority. A reduction in breast cancer, heart disease, diabetes and allergy-related illnesses would go a long way to making Maori health statistics look a bit more respectable.
But the barriers to breastfeeding are complex. The rapid drop off in exclusive breastfeeding by New Zealand mothers, from 50 percent in the first two weeks to just 10 percent at four-seven months, may be a reflection of one of the most serious barriers – the difficulty of combining employment with breastfeeding. Lack of commitment to built-in breastfeeding breaks in employment legislation doesn’t help.
Though many breastfeeding problems can be seen as iatrogenic, caused by intervention, LLL has favoured the nature and science approach, contrary to the astonishing number of people who make a “lifestyle choice” to feed their babies, at the earliest stage, food evolved for calves or kids (or, in the case of soy milk, beans!), but protest at precisely the same science that made those formulas. I wonder how Mothers Against Genetic Engineering can be so vociferous about GE fruit and veg for adults, but so silent about the artificial feeding of infants, the largest uncontrolled in-vivo GE experiment in human history. (And speaking of genetics, very recent research suggests that the DNA may be affected in families where breastfeeding doesn’t take place.)
And it is not just a matter of food. Ground-breaking research by New Zealand speech therapist Frances Broad, who was mystified by the sudden explosion of children, particularly boys, needing remedial reading, established a connection between poor jaw development, slow articulation and poor reading skills. Since the particular sucking action required by breastfeeding develops the jaw and facial muscles, the inevitable conclusion is that if you want your boys to read, breastfeed! Similarly, hand-eye co-ordination and binocular vision are assisted by breastfeeding on each side, so the focus of each eye (on the mother’s face) is strengthened.
If health and education benefits aren’t convincing, there’s always the environment. Breastfeeding uses no resources. No plastic, no tin, no rubber, no chemicals, no water, no energy. No pollution. It’s the ultimate “green” product. And it’s free!
Such multiple factors are why the World Health Organisation, which advocates exclusive breastfeeding for the first six months and continued breastfeeding for two years and beyond, would like countries like New Zealand to see breastfeeding in a wider socio-economic context. Anne Devereux, former director of LLL, agrees. “Breastfeeding isn’t just about infant feeding; it concerns the wellbeing of the whole family.”
Formula for grief
In 1981, in response to huge concerns about industry standards for infant formula and the way it was promoted, the World Health Organisation issued a code calling on governments to halt the advertising and promotion of breast milk substitutes and to require accurate and honest labelling. Some countries, such as Australia, chose to accept a virtually meaningless voluntary “industry code” formulated by manufacturers.
Maureen Mincham, author of the uncompromising and riveting Breastfeeding Matters, credits “a concerned economist, Brian Easton” and the Listener article “Formula for grief” (November 27, 1982) for exposing a similar sham in New Zealand. That led to the government’s rejection of the industry code in favour of accepting the WHO code in full – although LLL leader Ann Heritage is quick to point out that the code is not legislated and a quick flick through any family-centred magazine will show unlimited advertising of infant formulas and feeding accoutrements.