The Milky Way

Our mission is to restore the phenomenon of the nursing mother to the cultural landscape.

Chantal and Jennifer - The Milk WayAbout the Authors

Chantal Molnar, RN, MA, IBCLC (far left in photo), lives in Orange, California, USA, with her family. She worked more than 20 years for the University of California’s Irvine Medical Center.

Jennifer Davidson, RN, BSN, IBCLC (far right in photo, helping a client with Chantal), lives in Santa Monica, California, USA. She works with pediatrician Jay Gordon, MD, a member of API’s Advisory Board.

Together, Chantal and Jennifer produced “The Milky Way” documentary through Piece of My Heart Productions, which led them to cofound the Milky Way Foundation.

Did you know that, in the United States, 75% of all mothers attempt to breastfeed, but a meager 15% of American women successfully breastfeed?

Why do so many women start out breastfeeding but find themselves up against overwhelming obstacles? And why do so many other countries have a higher success rate, some as high as 96%? Jennifer, the hero in our film, “The Milky Way,” sets out to discover what happens between the beginning of breastfeeding and the reality of the statistics, which includes traveling to Germany and Sweden to find out what they do differently. Get a glimpse.

Behind the Film’s Name

We changed the name of the film from “Bottled UP!” to “The Milky Way” because of a painting Jennifer saw in a museum when she was in Spain. It is a painting by Paul Rubens of the creation of the Milky Way.

As the story goes, Zeus had an illegitimate mortal baby. He wanted the baby to become divine, so while Zeus’ wife, Hera, was sleeping, Zeus put the baby on her breast, which would impart divinity upon his son. Hera woke up, realized what was happening, and pulled the baby off her breast, spraying breastmilk all over the universe, creating the Milky Way.

We delved a little deeper and discovered that even the root of the word “galaxy” refers to breastmilk, so the Milky Way was created and named for mother’s milk!

Our Inspiration

Time and again in our lactation practice, we see mothers who have been saturated with fear: “Don’t sleep with your baby!” “Don’t nurse so much!” “Don’t pick up your baby so much; you will spoil her!” “Your baby is not gaining enough! Supplement!” “Get him on a schedule!” “Is she sleeping through the night?” “Slings are dangerous!” And on and on. You get the picture.

As lactation consultants, Jennifer and I do our best to guide mothers into what ordinarily would be second nature for them but has been scared out of them. We encourage mothers to follow the knowledge within and lead them to trust the process. We find that so many women have trouble with breastfeeding and self-confidence, and they are often made to feel inadequate by the very medical professionals being paid to serve them.

Our inspiration is the mothers. We are inspired by the many mothers who have taught us about trust and the many mothers whom we have empowered to trust in themselves.

Our mantra is: “Trust your body, trust your baby, trust yourself.” Jennifer and I have built our practice on this foundation: mothers are fully capable of knowing what their baby needs, and babies are competent to communicate their needs.

There is no baby without a mother. The mother is baby’s habitat—his home. When baby is in skin-to-skin contact or in close contact with mother, such as in babywearing or cosleeping, baby is able to synchronize heart rate and breathing rate with the adult.

This foundation is based upon the “MotherBaby,” the mother and baby as one unit, together—no separation at birth, early skin-to-skin contact, breastfeeding, cosleeping and babywearing. It is through frequent physical closeness that a baby communicates and mother responds. It is within this context that mother and baby express fully the programs within: the breastfeeding program in the baby and the mothering program in the mother. Being unhindered and unseparated releases the full manifestation of their intrinsic abilities.

That is the inspiration behind “The Milky Way.” We decided to complement our practice with a film, a culture-changing film that is as revolutionary as it is beautiful. We will take you on a journey that will outrage and incite, enlighten and inspire, as we expose the social programming that derails breastfeeding and explore why this is happening, who benefits and what is at stake.

Furthering the Breastfeeding Movement

“The Milky Way” contributes to the breastfeeding and parenting communities, as well as elevates women in general and transforms the cultural perception of breastfeeding. We empower mothers through a film designed to elicit each mother’s own embodied wisdom, and we encourage each woman to have confidence in herself during her journey through motherhood. Our film will counteract the century-long ad campaign that successfully vanquished the collective intuitive knowledge that women shared for most of history. We want to see women be so knowledgeable in how it can be that they will demand that medical professionals provide the kind of care that they want and need, because change in medicine is based on consumer demand.

Our mission is to elevate the nursing mother to a place in society where she receives all the necessary support to successfully nurse a child, where scientific evidence overrides marketing influences, and where a woman does not fear breastfeeding in public.

When all women are secure in their inner wisdom—their intrinsic knowing—and when they are confident and ready to step into their power and authority as mothers, our work will be done. This is our chance to make a tremendous difference in the lives of many women.

Breastfeeding is Normal

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Being embarrassed to breastfeed in public, as well as fear of being shamed for doing so, are some of the reasons why some moms never attempt to breastfeed. Others start out breastfeeding but give up after having a bad experience nursing in public or when they realize their child will no longer keep a cover on.

TaishaAbout the Author

Taisha Kelleher lives in Tampa, Florida, USA, with her family. She is the project coordinator of the Museum of Science and Industry’s “Breastfeeding is Normal” photo display.

About the Photographer

Patricia Cannon is a professional photographer with Sweet Plum Photography in Tampa, Florida.

When we see something every day, we quickly become desensitized to it. Present generations have not been exposed to breastfeeding much, if at all. The more they see breastfeeding happening around them, the more normal it will become.

_DSC7788_1 (2)During World Breastfeeding Week 2011, I came across some slideshows on Facebook with pictures of moms nursing in public from the “Nursing IS Normal” projects that have been coordinated in several states by Kathy O’Brien. I fell in love with the idea and first wrote a blog post about the project. Then I decided that something similar had to be done in the Tampa, Florida, USA, area, and I posted a link to my blog post in several forums and asked around for anyone interested in helping to make this come true here. Thanks to our local birth center and Facebook, soon there was a whole group of moms interested in making this project happen! I spoke with Kathy, and with her blessing, we decided to move forward under a different name: “Breastfeeding Is Normal: Anytime, Anywhere.”

Current partners are La Leche League of the Sunshine State, the Hillsborough County Breastfeeding Task Force and breastfeeding moms from the community. The project will be displayed at the Museum of Science and Industry (MOSI) as a permanent part of their “Amazing You” exhibit on the human body. Most public schools in Hillsborough County take their students on field trips to MOSI, and parents like to take their kids on trips there as well. It is a perfect place for children to be exposed to breastfeeding and to learn that it is a normal part of life.

_DSC7716_1 (2)Of course, we also hope that they are exposed to real moms nursing in public.

The goal is that, with nursing becoming more normalized in our society, more moms will initiate and continue breastfeeding because they no longer have to worry about hiding or being shamed. This, of course, will benefit babies in that more of them will be breastfed and get to experience the benefits of breastfeeding. More moms will also experience said benefits. My dream is that one day, when people see a mom breastfeeding, they are so used to it that they don’t even bat an eyelash.

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Nature’s Case for Breastfeeding

For so many women, breastfeeding was the turning point for our journey into Attachment Parenting. And one organization that many of us have to thank for our introduction to both breastfeeding and Attachment Parenting—even in the case of API’s cofounders Lysa Parker and Barbara Nicholson, coauthors of Attached at the Heart—is La Leche League (LLL) International.

rita brhelAbout the Author

Rita Brhel lives with her husband and three children near Hastings, Nebraska, USA, where she serves as a WIC Breastfeeding Counselor. She is the Managing Editor of Attached Family, API’s Publications Coordinator and an API Leader.

Jeanne Stolzer, PhD, Professor of Child and Adolescent Development at the University of Nebraska in Kearney, USA, whose research is known worldwide as an intelligent challenge to the current Western medical model that seeks to pathologize normal human behaviors including breastfeeding, shares her beginnings in LLL.

“Most people think that because of the research I do, I was raised in a granola-eating, breastfeeding, bare-footed family,” Stolzer said. “Nothing could be farther from the truth. The first breastfeeding baby I ever saw was when I was 18 years old, and I was mortified. Five years later, I saw a woman with a PhD breastfeeding a 3-year-old, and my immediate response was, ‘What is wrong with her?’”

Some years later, Stolzer herself was expecting a baby when a friend encouraged her to attend a LLL meeting: “I was very reluctant, but I went,” she said. As fate would have it, “I instantly felt like I was with kindred spirits.”

LLL led Stolzer to begin educating herself about breastfeeding. As she remembers: “I was reading and reading all this stuff and was getting madder and madder: Why didn’t my mother know this? Why didn’t my friends know this? And, gosh darn it, why didn’t my doctor know this?”

Learn the Basics of Breastfeeding Advocacy

Where Did the Mammal in Us Go?

Dr. Stolzer
Dr. Stolzer

“For 99.9% of our time on this earth, we have been hunters or gatherers, and we have been practicing esoteric mammalian parenting,” said Stolzer, meaning non-medicalized births, breastfeeding and staying in close proximity to our babies. “Look at what, in just 100 years, we’ve done: We’re supposed to be the top mammal on the planet, but we’ve managed to completely erase the mammalism in our lives.”

Conception, pregnancy, birth and breastfeeding are intricately linked together as one continuous process to give each baby the best start in life, Stolzer explains: “Most people see these as separate. They’re not. If you mess with one, you risk throwing off the whole connection.”

While there are a very small number of females in every mammal species unable to get pregnant, the United States has the highest infertility rate in the world among humans. But is there any wonder when we stop to look at what Western cultures are doing to the birthing and breastfeeding functions of this process? Stolzer finds it comical that most mothers won’t touch a cigarette or a caffeinated drink while they’re pregnant—which is commendable—but then have no problem in going to a hospital and having powerful narcotics mainlined into their arm during labor and birth. In the United States, 38% of women are getting Cesarean sections when, naturally, only 1 to 3% of births might actually require medical intervention.

Then mothers and their newborn babies are, more often than not, separated immediately after birth. If a mother is able to give birth vaginally, she is flooded with hormones, but by separating the mother from her baby, that hormone flow is interrupted. As if the breastfeeding relationship isn’t challenged enough by separation, then it has to overcome the ordeal of a hormonally-deficient mother and a drug-affected baby: “It takes 138 muscles alone in the jaw to nurse, and if you’re drugged, they won’t work,” Stolzer said.

The truth is, most Western physicians are not educated in breastfeeding. To be so, they must go on to continuing education because medical schools don’t teach lactation.

“I think women do the very, very best they can with the information they have at the time,” Stolzer said. “Breastfeeding decreases all forms of hospitalization, death and prescription drug use. That’s amazing, but how many women who are formula-feeding know this?”

Read the year’s most eye-opening Attachment Parenting research, including breastfeeding and bottle-feeding, through API’s Journal of Attachment Parenting

Introduction of Formula Feeding

Formula was developed with the mechanization of the dairy industry and is derived from whey, a byproduct of processing cow milk.

In 1910, only 2 to 13% of mothers formula-fed. After World War I, that statistic jumped to 65 to 70%, and the impression was that only the poor and the immigrants had to “resort” to breastfeeding. Formula feeding had become a status symbol of wealth, and physicians were supporting that formula feeding was superior to breastfeeding. The lesson learned here, says Stolzer, is to question your societal trends: “Formulas are manufactured by pharmaceutical companies. Look at who’s funding every study: If it’s a pharmaceutical company, don’t even read it—it’s propaganda.”

In reality, human milk is far better than any substitute milk. Human milk changes with each child, depending on the needs of that particular child during a particular time of the day, during a particular age of that child. Human milk—and breastfeeding, for that matter—quite simply, can’t be duplicated.

“Pumped milk is infinitely better than formula,” Stolzer said. “However, it would be a scientific fallacy to say that pumped milk is the same as milk from the human breast,” because of how breast milk changes throughout the day, not to mention that feeding by a bottle misses the intricacy of the relationship aspects of breastfeeding.

Local breastfeeding advocacy efforts are popping up all over; read about how one group of mothers are trying to Normalize Breastfeeding

Human milk is a dose-responsive, specific variable, meaning the response is specific to the dose: the more that a baby is breastfed and the longer a baby is breastfed, the more benefits that breast milk affords to the child and the mother. Research that began in the 1920s clearly shows that breastfeeding reduces the risk of myriad physical and mental health conditions for both baby and mother, through  protective antibodies and enzymes, and through the oxytocin and prolactin “love” hormones secreted with each breastfeeding interaction.

“Choosing not to breastfeed brings a halt to oxytocin and prolactin. This brings on the grief response in mammals,” Stolzer said. “That’s why we have [high] postpartum depression rates in this country. Because the body believes that we’re grieving.”

In addition, it’s important to note the differences between cows and humans on an animal level. While both are mammals, humans and cows are not nearly the same. There are two types of mammals on the earth, in terms of how they care for their young:

  • Caching—i.e., cows. These mammals give birth to young who are, soon after birth, able to walk, regulate their own temperature and be left alone for periods of time while the mother forages for food. Feedings are meant to be spaced to allow this, and therefore, the milk produced is high-protein and high-fat.
  • Carrying—i.e., humans. These mammals give birth to young who are unable to walk, regulate their own temperature or stay quiet for long periods of time alone, and therefore must be kept in close physical proximity to the mother. Feedings are meant to be continuous and on demand, and the milk produced is low-protein and low-fat.

Quite simply, cow or soy milk formula cannot be as good as human milk for human babies: “It makes sense: We have such a different brain than a cow, and a soybean doesn’t even have a brain,” Stolzer laughed.

All kidding aside, human mothers treat their babies like those of caching mammals. This is evident not only in formula sales—a $1 trillion industry—but also in the boom in sales of helmets meant to reshape the heads of babies whose heads are flattened on one side because the baby spends more time lying down than being held.

Another important argument against formula feeding is the increasing rate of food allergies in Western cultures, Stolzer said: “The number-one allergen in human populations is dairy products. The number-one ingredient in formula is dairy. Of course we’re doing this.”

Ever heard that breastfeeding makes babies fat? Read how to Rescue Your Baby from Obesity

Extended Breastfeeding is Best

According to World Health Organization recommendations, babies must be breastfed for at least two years to obtain optimal benefits. Developmentally, human children are designed to breastfeed well over two years of age. For example, permanent molar eruption doesn’t occur until the child is 5 to 7 years old. In another example, Stolzer shares: A child’s sucking needs last for three to seven years—evidenced by prolonged thumb-sucking, pacifier use and hair-sucking in older children.

The average breastfeeding weaning age worldwide is three to four years. In the United States, weaning typically happens at only six weeks, the time when women return to work outside the home. The breastfeeding research available clearly shows that if all women in the United States breastfed exclusively for just six months, the nation would save $3.6 billion a year, mostly in health care costs and time spent paying parents for sick time to stay home to care for their children. If they breastfed exclusively for one year, the savings would climb to $7 billion a year.

“Five thousand to 6,000 years ago, mothers were breastfeeding their children until about 7 years old. They were ensuring the survival of the human species,” Stolzer said. “Not only is the human brain not done growing until the child is 5 to 7 years old, but the human immune system is not fully developed for five to seven years.”

Breast milk naturally has more antibodies available for the older child, because babies are designed to always be with their mothers. That’s why breastfed babies in child care centers still get sick: The antibodies in their mother’s breast milk are designed to ward off family germs, not germs from the whole community. The antibody load naturally increases as the child becomes more mobile, Stolzer explains.

It’s time that Western cultures quit playing it safe when it comes to educating women about breastfeeding, Stolzer says. The benefits of breastfeeding are consistently dependent not only on the frequency and intensity of each nursing session but also on the duration.

Read about the beginnings of “The Milky Way” documentary exploring the barriers to successful breastfeeding in the United States

Worth the Work

One of the concerns of Attachment Parenting is the physical work involved in the early years, especially the first few months, when the baby’s natural sleeping and feeding schedule is so contrary to the parents’ pre-baby schedules and to what the parents want to return to because of what Western culture promotes as “normal.” But Stolzer encourages parents to stick with it.

“I know it feels really intense right now—and it is really intense right now—but in the time between birth and death, this really intense time is very small,” she said. “Attachment Parenting does not ensure that babies won’t cry or make choices that will hurt you or make you so mad you could flip,” she added. “But if you lay that foundation with Attachment Parenting, that path [of loving interaction] will always be there for them to find again.”

My Journey to Breastfeeding

When I was little, I had a favorite baby doll. She was big enough for me to cuddle in my arms, was plump with silvery curly hair and had a round face. She looked like a cherub, and I loved her. I brought her with me everywhere I went. I changed her diapers, I wrapped her in warm blankets, I washed her face and I fed her bottles.

About the Author

Heidi Ripplinger lives in Crystal, Minnesota, USA, with her family.

Yes, that’s right, bottles—the kind that had the pink nipple and the “milk” that flowed back and forth. I even had one that was divided into two liquids: orange juice and milk.

I never learned about nursing—well, that’s not entirely true. I think I intuitively understood what breasts were for, but I only saw one woman during my childhood breastfeed her baby, and she hid under a blanket, tucked away in an out-of-the-way room of her home while we were visiting.

I was 8 years old. I was exploring the house and stumbled across her sitting on a couch, all covered up, holding her baby. I asked her what she was doing under there, and she said she was nursing. I was confused. I had never heard that word before. I wanted to check it out.

I reached in to look under the blanket and was quickly told that it was private and I shouldn’t look. I felt embarrassed and humiliated, like I had done something terribly wrong and vile. I thought she was ashamed because I couldn’t come up with any other reason why she would hide what she was doing.

Later, I told my parents. My father laughed it off, and my mother looked annoyed. Now I really felt terrible. No one talked to me about it. No one helped me understand. No one paid much attention to the situation at all.

Fast forward to my 20s: I had a friend who just had her first baby. She was adamant that she would never breastfeed her children. She was convinced it was akin to incest, especially when they were older than three months. Because of my earlier experiences with nursing and because of being raised in a culture where women’s bodies were exploited and devalued for nothing more than a man’s plaything, I was inclined to agree with her.

But there was something gnawing at me. I couldn’t really tell what it was, just a quiet tapping deep in my soul. It moved around a lot, and it was the lightest whisper, so it took me a long time to hear it and even longer to listen. I had to be quiet. I had to be still. I needed to learn to sit with my baggage and noise that accumulated over the years of passive conditioning.

It took a very long time. It wasn’t until I was pregnant myself that the floodgates finally opened. It was akin to ocean waves crashing to the shore: I would nurse my babies. Better yet, I would nurse them on demand, openly—wherever I was—proudly and with no reservation. And I would nurse them for as long as they wanted. I felt released of my shame I had harbored since that fateful day long ago when I stumbled upon the breastfeeding mom. I felt empowered knowing I would be the one to give my children the perfect food, specifically made for them. No one else can do that, just me.

I nursed my first child until he was 4 years old. I’m nursing my second child, who turned 4 years old in June.

In the beginning, I had no idea what I was doing. I remember the first time I brought my firstborn to my breast. He was 15 minutes old. My midwife had helped me get out of the birthing tub and settled into a rocking chair that was in our living room. I was so tired, and my arms felt like Jell-O. We tried nursing, but my son just wanted to root and cuddle.

The next time was about an hour later. I was comfortably in bed and felt refreshed after having a nice dinner. My little love was hungry, but I couldn’t figure out how to get him to latch. I was so clueless to such a normal function of the human body, of our human connection.

Thankfully, my midwife was there and was experienced herself. With a little coaching and a lot of patience, my son filled his belly and I filled my soul. In that moment, I knew what it was to be a momma—his momma—and I was in love. I could feel another voice in my soul starting to emerge, a voice that would eventually lead me to understand where our power as women lies. Once again, I needed to be still and listen.

Breastfeed, Chicago!

Public breastfeeding can infuriate us, scare us, make us feel ashamed or empower us. For one Chicago mom, it empowered her to take action and create an organization that would focus on advocating for breastfeeding at a larger level in her city. She wanted not only to help raise awareness of the benefits of breastfeeding but to ensure that mothers feel comfortable feeding wherever and whenever their babies are hungry.

Patricia MackieAbout the Author

Patricia Mackie, MS, LPC, lives with her husband and three children in Naperville, Illinois, USA. She is API’s Professionals Liaison, a member of the API Editorial Review Board, an Abstract Writer for the Journal of Attachment Parenting and an API Leader. She is also a marriage and family therapist, the author of the “Three’s a Crowd” curriculum for new parents and the founder of Connecting 1 Day at a Time for couples with children.

carrie lapidusAbout the Photographer

Carrie Lapidus lives in Naperville, Illinois, USA, with her family. She is an Attachment Parenting advocate, professional photographer and blogs at Attachment Photography. See more of her work, including a collection titled “Attachment,” at Carrie Lapidus Photography.

Breastfeed, Chicago! is making changes for Chicago, Illinois, USA, one mom at a time, through a very talented board of directors that help to put together the group’s advocacy campaigns. I sat down with Katrina Pavlik, the founder of Breastfeed, Chicago!, to find out more about the organization and advice she has for others who want to advocate for breastfeeding in public. We met on a brisk  day on the southwest side of Chicago and sat down over some hot coffee to chat about breastfeeding.

PATRICIA: Tell us how Breastfeed, Chicago! came to be.

Katie A

KATRINA: In 2011, I created a closed Facebook group to invite people to start a conversation about breastfeeding in Chicago. Within six hours, it had grown to 400 people. (As of this writing, the group boasts a membership of 2,287 members, and more people are added daily.)

I saw a need for a community that could discuss how to make Chicago more breastfeeding friendly. From the Facebook group, we expanded and added the Breastfeed, Chicago! blog and resource list.

I wanted to see moms having more of a voice in writing policies.

“I see a Chicagoland where mothers don’t have to fret or wonder if their nursing will be met with hostility. Most of all, I see happy moms and babies.” ~ Kelli Paulus, hypnobirthing practitioner and birth doula

PATRICIA: Chicago and the surrounding suburbs boast a high number of La Leche League (LLL) and Breastfeeding USA groups. What is different about Breastfeed, Chicago?

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KATRINA: LLL and Breastfeeding USA are so important. They provide breastfeeding support, which is critical for new moms just getting started.

Our organization is about advocacy and policy. We are working to change the view of breastfeeding. We are working on raising awareness, educating the public and advocating for policy changes.

“I see moms unafraid to breastfeed in public. I see our role as advocates becoming obsolete before my daughters become mothers.” ~ Amy Capulong, gymnastics coach and birth doula

PATRICIA: Tell us about the advocacy efforts Breastfeed, Chicago! is working on.

KATRINA: One of the big projects we are working on is a letter-writing campaign. One of our board members drafted a letter that we send out to businesses. It basically goes over Illinois breastfeeding laws and gives some information about working with breastfeeding moms. We ask that the information be posted in the employees’ space, such as a break room, so all of the employees from the top down are receiving this information. The letter is also available on the Breastfeed, Chicago! resource list so that parents can print it out and send it to any business that they feel would benefit from this information.

Maura F
Maura F

We also are working on a sticker campaign. We have printed up Breastfeed, Chicago! window decals that businesses can place on their doors or windows that indicate that this is a breastfeeding-friendly business.

We really want this to be mom-driven, so we have these travelling baby cafes in the summer. We meet in different areas around the city, and moms can get together, have a cup of coffee and chat. It’s an opportunity for us to brainstorm ideas that will help make Chicago more breastfeeding friendly. We take the stickers with us and moms can take a stack and hand them out at their favorite businesses, restaurants, et cetera.

The blog also has an advocacy tool kit that can be downloaded. It includes information on your rights as a breastfeeding mom in public and at work. It has tips for advocating for yourself and your child, questions to ask your pediatrician, tips to make breastfeeding in public more comfortable. It also includes a letter that you can send to your birthing hospital to express your gratitude or disappointment with their approach to breastfeeding. And it includes the window sticker and a letter that accompanies the window stickers, explaining the sticker campaign.

“I see a city and suburbs where women are eager to try breastfeeding, where they are confident and encouraged about breastfeeding. I see babies thriving. I see women helping each other and a sense of community growing.” ~ Elizabeth Handler, stay-at-home mother

PATRICIA: I noticed you didn’t mention nurse-ins.

Erin M

KATRINA: Breastfeed, Chicago! has never implemented a nurse-in. We want to circumvent the nurse-in. We want to normalize breastfeeding and implement interventions that will make this normal. Nurse-ins are a tertiary intervention. We are looking at what can we do before that.

When thinking about a nurse-in, there are a few factors we want to think about. One thing I always try to think about is the mom-to-be, the woman who hasn’t had her first baby yet. What message does a nurse-in send to her? [That] this is so abnormal people have to stage protests in order to do it. We want her to get the message: “This is what all my friends are doing. I see it. It’s normal.”

Nurse-ins also serve to embarrass the individuals involved. Similar to the way we raise our children, we don’t want to punish and embarrass people into change. We want to teach them and educate them into changing their behavior.

“I see a city and suburbs where women can breastfeed or pump at any time, anywhere, without fear of being singled out or shamed for choosing to use their body to feed a child. I see doctor’s offices where you can receive goody bags full of only breastfeeding-supportive material and hospitals where every single mother meets with a lactation counselor before discharge.” ~ Naa Marteki Reed, web developer and tax preparer

PATRICIA: What advice would you have for parents in other cities who would like to take on a venture like Breastfeed, Chicago!?

Kelly Z

KATRINA: Use social media. Moms are online all day everyday. Moms will come together and build community. Once that community it built, moms will start to share their needs. Make sure you are listening, and when a mom brings up a need, step back and contemplate and ask yourself, how do we make this better for all moms?

Make sure you reach out to your local breastfeeding professionals. Make them feel important, and ask them to be a part of what you are doing.

And be aware that things move slowly.

“My dream for Chicago is that it will become the most breastfeeding-friendly city in the country. Moms will be seen breastfeeding their children anywhere, anytime, and it will be considered a normal, natural way of feeding our children.” ~ Katrina Pavlik, founder of Breastfeed, Chicago!

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Erin M & Dyana G

Attachment Parenting Inspires Grad Student’s Paper on Supporting Breastfeeding Teens

I was born and raised in New York City, one of three girls. My father was a physician; my mother is a teacher but spent much of my childhood as a stay-at-home mother. As a child, I always knew that when I grew up, I wanted to be a mother.

Ellen Hollander-SandeAbout the Author

Ellen Hollander-Sande, RN, lives in New York City, USA, with her family.

As I got older, an interest in mental health and a stint assisting my father with his medical practice led me to nursing school. Upon becoming a registered nurse in 1998, I began my career working in in-patient medicine in the adult and geriatric population and went on to working with HIV/AIDS patients, palliative care, medical step-down and respiratory care. I later worked in labor and delivery, including some rotations at an in-patient birth center. It was a big change and a fantastic experience.

In 2005, I gave birth to my first child, and with some initial help from my wonderful postpartum nurse and a lactation consultant, my focus turned toward a different kind of “nursing.” As I adjusted to my new role of motherhood, breastfeeding took center stage, not only in terms of the time spent nursing but in the emotional connection I felt in my relationship with my son. I nursed throughout my second pregnancy, and when my younger son was born in 2006, tandem nursing was a great way to maintain closeness with my eldest and a sweet way for the brothers to feel connected to each other. Thanks to Art Yuen, amazing API Leader of API-NYC, for supporting me through the amazing adventure of motherhood!

Having taken time off from paid employment and feeling so much appreciation for this aspect of my mothering experience, I channeled my nursing skills and energies into assisting new mothers whenever I could, whether with advice or hands-on assistance for a neighbor or a friend-of-a-friend who had been referred to me for support. Inspired to integrate this passion into my future practice, I began an online lactation education program to further my knowledge base.

In 2012, I returned to New York University’s College of Nursing to pursue a master’s degree and become a family nurse practitioner (FNP). In this role, I will be able to provide primary care for patients across the life span. It is my hope that combining this role with breastfeeding knowledge will best enable me to support mothers and babies in their breastfeeding relationships.

The paper “Identifying Best-Practice for Increasing Breastfeeding Initiation Rates Among Adolescent Mothers” was a group effort, and as such the inspiration stemmed in part from the combination of interests and experiences of the four authors: Eliana Roshel, Sarika Downing, Maria Mendez and me. We knew almost right away that breastfeeding promotion was our common thread, and we quickly narrowed our focus to a group that isn’t often mentioned in the breastfeeding literature: adolescent mothers.

I would be remiss if I did not thank our professors, Drs. Rona F. Levin and Nancy E. Kline, for their guidance and support in the research and writing of this paper. The paper highlights that adolescent mothers can benefit from interventions tailored to their developmental stage and to the unique circumstances this population encounters. We are accustomed to thinking of the needs of adult mothers, but there is so much to be gained by opening our perspectives to think of the needs of younger mothers as well.

What can we do to support adolescent mothers in breastfeeding their infants? Two of the studies we looked at utilized the Breastfeeding Educated and Supported Teen (BEST) Club, developed by Eileen M. Volpe and Mary Bear, where adolescents learned about breastfeeding, nutrition, safety and maternal health in an atmosphere that was interactive, nonintimidating and supportive (Volpe & Bear, 2000; Wambach et al., 2011). Games were utilized and prizes were given each week to encourage participation. We can better reach out by providing these types of services to the youngest mothers in our communities, who may not be well-served by support groups and classes geared towards mothers in their 20s, 30s and 40s.

Another point that may be of use to us is an inadvertent finding by Donna Sauls and Jane Grassley (2012) as they studied their Supportive Needs of Adolescents During Childbirth (SNAC) program. One of the possible confounding factors noted in their study was that the experimental group had more of the adolescents living with their parents, whereas adolescents in the control group were more likely to live with their significant other. This warrants further study, but also serves as a reminder to look not only at the adolescent mother as an individual but in the context of her family environment.

The Paper’s Abstract

Breastfeeding rates among American adolescent mothers are consistently lower than those observed within the adult population. Adolescent mothers are a unique population who face challenges specific to their age group regarding initiation of breastfeeding. Interventions aimed at increasing breastfeeding rates in this population, specifically targeted to their developmental stage, are vital though rarely studied.

Through a strategic search, three studies were identified for evaluating the effects of various interventions on breastfeeding initiation rates. The interventions examined in each study were specifically designed for this population, including guidance from intrapartum nurses, educational programs and peer support. Two of the three studies found significant increases in breastfeeding initiation in their treatment groups; a third initially showed an increase in initiation rates, but this result became insignificant once the data were adjusted for covariates.

Synthesis of the evidence supports educational and supportive interventions tailored to the needs of the adolescent mother to increase rates of breastfeeding initiation in this population. Implications for practice include recommendations for utilization of the BEST Club within high schools, prenatal clinics and hospitals; training of intrapartum nurses in the SNAC program; and improved support of breastfeeding in high schools.

Reader Poll: Breastfeeding

Breastfeeding may be natural, but it’s not always easy. What was your biggest challenge?

  • 27% Getting a good latch
  • 24% Managing my milk supply
  • 21% Thrush, plugged milk ducts, mastitis, nipple cracks, etc.
  • 12% Returning to work or school
  • 9% Finding support
  • 6% Hard to do while caring for other children
  • 2% Didn’t like it
  • 25% Had no problems

From The Attached (readers could choose more than one option; statistics do not add up to 100%)

Grad Student’s Project Educates Health Care Professionals on Extended Nursing

Lauren extended bf photo projectTwo years into her Master of Public Health project at the State University of New York (SUNY), USA, Lauren Cockerham-Colas created an art exhibit titled “abNormally Nursing.”

The display consisted of 22 photographs of mother-child dyads, selected from the portraits of more than 50 families from five U.S. states shot by Lauren over a year’s time, along with extended nursing facts. The exhibit was used as a research tool to evaluate and influence the knowledge and attitudes of health care professionals toward extended breastfeeding.

The results were published as “Exploring and Influencing the Knowledge and Attitudes of Health Professionals Towards Extended Breastfeeding” in the January 2012 issue of the journal Breastfeeding Medicine.

Lauren was also honored with SUNY’s Arthur and Patricia Robins Award for Distinction for the project, and the display has since been a featured exhibit of the Museum of Motherhood in New York City, USA.

Now having graduated and working in public health, Lauren is considering publishing a book to help parents in educating others about extended nursing.

The Paper’s Abstract

Although many U.S. professional health organizations have policy statements that support the breastfeeding of children beyond one year (extended breastfeeding), the actual attitudes of health workers toward this practice have not been explored. The purposes of this study were:

  1. to explore the knowledge and attitudes of various U.S. health professionals toward extended nursing
  2. to pilot an educational display for U.S. health professionals to promote their knowledge and attitudes toward extended breastfeeding.

A total of 84 participants in a New York City academic medical center provided responses to a structured, self-administered questionnaire given before and after an educational display.

Respondents reported negative attitudes toward extended breastfeeding at baseline, with negative attitudes increasing as the age of the breastfed child increased. After education, the percentage of participants who found breastfeeding acceptable for 1- or 2-year-old children increased from 61 to 89%. Acceptability of 3- or 4-year-old children breastfeeding increased from 22-41%.

Viewing educational media concerning older nursing children may lead to more positive attitudes toward extended breastfeeding among health care professionals.

Extending Nursing Around the World

As expectant parents, we have very likely heard that “breast is best.” This is what we may imagine next: a new mom with her sweet, precious newborn positioned lovingly at the breast. But for how long is breast the best? What happens when baby’s first tooth appears? How about when baby starts walking?

Rivkah EstrinAbout the Author

Rivkah Estrin, DONA, lives in Miami, Florida, USA, with her family. She is a childbirth educator and postpartum doula.

Across the globe, breastfeeding past 12 months is more than just possible, it’s the norm. UNICEF’s report entitled “The State of the World’s Children 2012” collects data about breastfeeding across the globe. Included in this report are the following statistics:

  • 91% in Bangladesh
  • 43% in Cambodia
  • 49% in Costa Rica
  • 88% in Ethiopia
  • 46% in Guatemala
  • 77% in India
  • 50% in Indonesia
  • 77% in Malawi
  • 95% in Nepal
  • 72% in Papua New Guinea
  • 84% in Rwanda
  • 84% in Sri Lanka

What do these numbers represent? The number of children breastfeeding at age 20-23 months. Impressive figures. Let’s compare this to the other side of the spectrum—countries with little or no data to suggest breastfeeding at the same age:

  • United States
  • United Kingdom
  • Canada
  • France
  • Germany
  • Mexico

Why the discrepancy? Why does the data from some countries point to a majority of nursing toddlers, while “modernized” nations don’t have any data to report? One word: Support. There just isn’t a lot of support for the nursing mother-toddler relationship in Western cultures.

Benefits of Extended Nursing

The American Academy of Pediatrics recommends “exclusive breastfeeding for about the first six months of a baby’s life, followed by breastfeeding in combination with the introduction of complementary foods until at least 12 months of age and continuation of breastfeeding for as long as mutually desired by mother and baby.”

The World Health Organization (WHO) suggests exclusive breastfeeding for six months and continued breastfeeding for two years. As mothers, as caregivers, we understand breast is best for young babies, but why keep nursing—what are the benefits of extended breastfeeding?

According to Kelly Bonyata, IBCLC, better known as Kellymom, of St. Petersburg, Florida, USA, in the second year (12-23 months), 448 milliliters of breast milk provides:

  • 29% of energy requirements
  • 43% of protein requirements
  • 36% of calcium requirements
  • 75% of vitamin A requirements
  • 76% of folate requirements
  • 94% of vitamin B12 requirements
  • 60% of vitamin C requirements

Bonyata also states that breastfeeding toddlers between the ages of one and three have been found to have fewer illnesses, illnesses of shorter duration and lower mortality rates. According to the WHO, “a modest increase in breastfeeding rates could prevent up to 10% of all deaths of children under five: Breastfeeding plays an essential and sometimes underestimated role in the treatment and prevention of childhood illness.”

And the American Academy of Family Physicians states: “As recommended by the WHO, breastfeeding should ideally continue beyond infancy, but this is not the cultural norm in the United States and requires ongoing support and
encouragement. It has been estimated that a natural weaning age for humans is between two and seven years. Family physicians should be knowledgeable regarding the ongoing benefits to the child of extended breastfeeding, including continued immune protection, better social adjustment and having a sustainable food source in times of emergency.” Furthermore, “If the child is younger than two years of age, the child is at increased risk of illness if weaned.”

The benefits of breastfeeding past baby’s first year are numerous and include benefits for mom as well. The New York Times reported in 2009 on a study by Stuebe et al that stated “of women with an immediate relative, like a mother or a sister, who had breast cancer, those who breastfed had a 59% lower risk of premenopausal breast cancer.” The article goes on to discuss additional health benefits to mom, including a reduced risk of osteoporosis, ovarian cancer, high blood pressure and heart disease.

Separately, there is a huge emotional angle to the comfort and closeness that extended breastfeeding offers an adventurous, curious, fall-prone toddler. Holding a child close, loving away the pain and enjoying some quiet snuggle time with a toddler who is often too busy to sit on mom’s lap are some benefits to breastfeeding that can’t be quantified. This is not to say that a mother can’t calm or love her toddler without nursing. However, the hormonal and neurological comforts offered by mom’s milk work in a special way. Settling a cranky 14-month-old by putting her to the breast is a loving way to transition this almost-baby to an almost-kid. What a sweet, gentle way to bridge the gap between dependent infant to independent child.

In an article for Parenting magazine, William Sears, MD, a pediatrician in Capistrano Beach, California, USA, author of the Sears parenting library and member of API’s Advisory Board, wrote about how extended breastfeeding is “better for your toddler’s behavior. We have many extended breastfeeders in our pediatric practice, and I have noticed that breastfed toddlers are easier to discipline. Breastfeeding is also an exercise in baby reading, which enables a mother to more easily read her baby’s cues and intervene before a discipline situation gets out of hand. Nursing is a wonderful calming tool on days when Mom needs to relax and to stave off an impending toddler tantrum.”

Additionally, Jack Newman, MD, of the International Breastfeeding Centre in Toronto, Ontario, Canada, author of The Ultimate Breastfeeding Book of Answers, states that “the child who breastfeeds until he weans himself (usually from 2 to 4 years old) is generally more independent and, perhaps more importantly, more secure in his independence.”

Lack of Support

All this being said, extended breastfeeding is more than a checklist of benefits versus risks. As with all parenting decisions, it comes down to how the family functions and what works best for everyone involved. So what do we need to do to afford the opportunity, should parent and baby desire, to nurse into toddlerhood?

Toddlers often nurse at bedtime or when they are hurt, upset or feeling unwell. It is common in these circumstances for nursing to take place in the privacy of the home. Not many opportunities present themselves for children of a certain age to nurse in anyone else’s company—not by design but by default. Perhaps this is what perpetuates current attitudes toward nursing past baby’s first year. On the go, at the park, in the shopping malls and libraries of our cities and towns, these little people are too busy exploring to nurse. When they return home and want to reconnect with mom in a comforting, routine fashion, settling in on the couch and nursing can help these little explorers feel safe again.

And American actress Mayim Bialik, PhD, author of Beyond the Sling, told in an interview on extended breastfeeding: “I believe that children outgrow the need to nurse just as they outgrow the need to crawl or poop in a diaper.”

In Western societies, many mothers assume that babies should be weaned once they reach their first birthday. But what if a mother isn’t ready to wean her walking, talking 13-month-old son? What if the messages this mother received were those of understanding and lacking judgment? What if we allowed families to find their own rhythm without casting our own aspersions on them? What if the only repercussion to supporting extended breastfeeding was to have healthier, more emotionally secure kids?

The Real Breastfeeding Story

The recent controversies generated by depictions of Attachment Parenting in the Western media and elsewhere have revealed a fairly astounding degree of misinformation about infant and child development. Most especially, the  media’s fetishist focus on “extreme breastfeeding” has revealed the tremendously wide chasm that exists between official medical recommendations about breastfeeding and the actual reality and perception of the practice on the ground.

Sheena SommersAbout the Author

Sheena Sommers, MA, lives in Victoria, British Columbia, Canada, with her family. She is working on her PhD in history and has a special interest in the history of childbirth, maternity care and child-rearing trends.

Discussions generated by overly sexualized and highly sensationalized depictions of breastfeeding have often helped only to bolster a set of beliefs about the practice that are as dangerous as they are inaccurate. Though breastfeeding is touted by almost every recognized medical body as being one of the best things a mother can do to ensure the health and well-being of her child, the fact remains that very few infants are exclusively breastfed during their first six months of life and even fewer still are breastfed beyond their first year as official medical guidelines recommend.

Breastfeeding older babies, sometimes referred to by advocates as full-term breastfeeding, means different things to different people.  Though some feel that nursing an infant past one year should be considered full term, others define it as breastfeeding a child past the age of two. Perhaps more important than any specific age reference is instead a commitment to continue breastfeeding until a child initiates the weaning process.

While beliefs and approaches to breastfeeding have certainly varied widely through time and place, the current level of societal discomfort breastfeeding engenders is without doubt an anomaly. What has since our earliest days been central to our very survival as a species has, more recently, been made to seem—by some of the more vocal critics at least—as an unnatural, immoral and even perverse practice when engaged in beyond the first year of an infant’s life. Thus, mothers who breastfeed their toddlers and very young children have been called everything from odd and eccentric to sexually perverse and even abusive.

What may therefore come as a shock to many in the West today is that from an historic and cross-cultural perspective, breastfeeding older babies and very young children is the norm. As Cornell University (USA) anthropologist Meredith Small, PhD, surmises in her groundbreaking work Our Babies, Ourselves: How Biology and Culture Shape the Way We Parent, the “hominid blueprint of the way babies were fed for 99% of human history indicates breast milk as the primary or sole food until two years of age or so, and nursing commonly continuing for several more years.”

Breastfeeding children until the age of three or four years has been the norm throughout much of human history and remains so in various parts of the world today. Even as late as 1800, an infant born in the United States could expect to be nursed for somewhere between two to four years.

What happened over the last 200 years to have so dramatically altered breastfeeding patterns is too complicated a history to review here. It is needless to say, however, that despite no shortage of scientific and medical evidence to support much longer-term breastfeeding, this has not been enough to sway popular practice or belief in any large measure. In the United States, Canada and elsewhere, breastfeeding beyond a year—or two for the more progressive types—raises eyebrows and even ire amongst some otherwise seemingly rational people. As discussed further below, though breastfeeding rates are on the rise, the increases are small, and breastfeeding older babies is still a far cry from the cultural norm in the West.

Read this parent’s Journey to Breastfeeding for an understanding of how Western society’s breastfeeding attitudes undermines future mothers

The Science

Photo submitted by Chelsea Smith of Greeley, Colorado, USA
Photo submitted by Chelsea Smith of Greeley, Colorado, USA

Not only does the historical and anthropological evidence suggest that weaning before age two is unusual, but from a purely biological perspective, nursing a child through the toddler years is not in the least bit abnormal. In fact, the typical age for child-led weaning from a physiological standpoint has been estimated to fall within the broad range of two and a half to seven years of age.

As Katherine A. Dettwyler, PhD, an anthropology professor at the University of Delaware (USA), has demonstrated, this large spectrum is based upon an analysis of various biological and physiological factors derived from comparisons to other mammals of similar size. When looking at the relationship between gestation times and weaning for instance, human babies are geared to wean somewhere around four and a half years of age. Other relevant mammalian comparisons also support a much longer breastfeeding duration, including:

  • the eruption of the first permanent molars—5.5 to 6 years
  • adult body weight—4 to 7 years
  • adult body size—2.8 to 3.7 years.

Even the most conservative estimate, derived from an analysis of human birth weights, would suggest natural weaning occurs between 25 and 32 months of age.

Read more on Extended Nursing Around the World

The health benefits of breastfeeding are, of course, much more widely acknowledged. Not only do breastfed babies suffer fewer childhood illnesses and recover faster when ill, but the benefits continue to accrue throughout their adult lives. In every scientific study comparing breastfed babies and formula-fed babies, the breastfed babies have been shown to have a lower risk of disease and to score higher on cognitive functioning.

Breastfed babies have a much lower risk of dying from Sudden Infant Death Syndrome (SIDS) than do their non-breastfed counterparts; the formula-fed infants being, in fact, twice as likely to die from SIDS. According to “The Surgeon General’s Call to Action to Support Breastfeeding 2011,”  formula-fed infants are also at a higher risk of common childhood infections, including gastrointestinal problems and ear infections, with the risk of the latter being a whopping 100% higher than in their breastfed counterparts.

The same report goes on to say that babies who are exclusively breastfed during the first four months of life have a 250% lower risk of being hospitalized for lower respiratory tract disease and a lower risk of respiratory infections. Breastfed babies also have a lower risk of developing leukemia. Formula feeding, as opposed to breastfeeding, is furthermore associated with an increased risk of some of the most serious chronic diseases of our time, including type 2 diabetes, childhood obesity and asthma.

While the early months are by far the most important with regard to the benefits of breastfeeding, research has shown that the health benefits of breast milk are cumulative. Thus, babies breastfed for 18 to 24 months do better than those breastfed for only the first six months, though as mentioned, the early months are certainly the most crucial.

While as of yet no large scale studies have been published on the specific health benefits of breastfeeding past two years of age, as Dettwyler and others have convincingly argued, there is little reason to believe the rewards cease immediately upon a child’s second birthday. Research has conclusively shown that the specific qualities of breast milk change over time in order to meet the nutritional needs of children as they grow. As such, there is evidence to suggest that breastfeeding beyond two years continues to offer important health benefits. As one of the foremost experts on the subject, Jack Newman, MD, at the International Breastfeeding Centre in Toronto, Ontario, Canada, argues, “Breastmilk still contains immunologic factors that help protect the child even if he is two or older.”

Mothers benefit enormously from the breastfeeding relationship too. For instance, it has been shown that the longer a woman spends breastfeeding, the lower her risk of ever developing breast cancer. Likewise, women who have never breastfed have a 27% higher risk of developing ovarian cancer compared to women who have breastfed for some period of time. Studies have also shown that breastfeeding for longer can maximize these protective effects. Overall, the report by the U.S. Surgeon General cited above concludes that “exclusive breastfeeding and longer durations of breastfeeding are associated with better maternal health outcomes.”

Breastfeeding Rates

Christina Pond
Photo submitted by Christina Pond

The “Breastfeeding Report Card—United States, 2012,” published by the U.S. Centers for Disease Control and Prevention (CDC), found that while national breastfeeding rates are on the rise, there is still a very long way to go in terms of meeting guidelines set out by almost every recognized medical body or health association across the globe.

While current recommendations as set by the World Health Organization (WHO) and echoed by many other organizations suggest that breastfeeding be continued for two years or longer if mutually desired by mother and child, the majority of infants in the United States are weaned by six months of age. Thus, although 76.9% of women in the United States initiate breastfeeding at birth, just under half of these women are nursing at six months and only a quarter of them are still breastfeeding at one-year postpartum.

WHO guidelines likewise stress the importance of exclusive breastfeeding for the first six months of an infant’s life. Exclusive breastfeeding means giving the baby nothing but breast milk during this time. Again, despite the slew of data on the vital importance of following these recommendations, according to the U.S. National Immunization Survey (latest data for 2008), only 14.6% of babies are exclusively breastfed at six months.

What was your biggest breastfeeding challenge? View results of the Attached Family reader poll

As surmised by the Surgeon General’s 2011 Call to Action, although “many mothers in the United States want to breastfeed, and most try … within only three months after giving birth, more than two-thirds of breastfeeding mothers have already begun using formula.” This statistic is hardly surprising when one considers that in a study co-funded by the CDC and the U.S. Food and Drug Administration, it was found that almost half of breastfed newborns were being supplemented with formula while still in the hospital.

From a purely economic vantage point, these findings are extremely important. In fact, a study published in the April 2010 issue of the journal Pediatrics examined the costs (adjusted to 2007 dollars) associated with various illnesses including SIDS, hospitalization for lower respiratory tract infection in infancy, atopic dermatitis, childhood leukemia, childhood obesity, childhood asthma and type 1 diabetes, and found that if “90% of U.S. families followed guidelines to breastfeed exclusively for six months,” the direct and indirect savings of medical expenses would equal some $13 billion annually.

Read about how Attachment Parenting Inspired a Grad Student’s Paper on Supporting Breastfeeding Teens

Challenges and Barriers

As evidenced above, it is quite clear that the widely available wealth of information concerning the array of physical, physiological, social, emotional, cognitive and even fiscal benefits breastfeeding provides has not been enough to alter public
practice on a large scale. Thus, though the medical evidence is unambiguous and educational campaigns to shore up support for breastfeeding are now common, very few families seem to be able to actually put these recommendations into practice.

Why might this be? As revealed by a 2005 U.S. National Survey conducted by the nonprofit Families at Work Institute, more than 60% of mothers of infants and young children work outside the home. U.S. law requires only 12 weeks unpaid maternity leave be afforded to new mothers and this only for companies with 50 employees or more. A report by the National Partnership for Women and Families found that almost two-thirds of women are left without access to employer-provided short-term disability benefits, while nine out of 10 members of the workforce are unable to draw upon employer-provided paid leave to care for a new infant.

Another study published in the February 2012 issue of the journal American Sociological Review revealed that those women who breastfeed their infants beyond six months see a steeper decline in their earnings than those working women who use formula or wean their babies earlier. As Phyllis Rippeyoung, one of the study’s researchers suggested, the results of the study demonstrate that “at least as work is organized right now in the U.S., there does seem to be an incompatibility between breastfeeding for a long duration and working for many women.”

This is, of course, not to say that women who work outside the home do not, or cannot, practice longer-term breastfeeding. However, as only about a third of even the largest companies in the United States provide women with a secure area to express breast milk, doing so can often require an extremely high level of ingenuity and commitment.

Studies like those above highlight a reality too often ignored in breastfeeding campaigns: breastfeeding is both time and labor intensive. Without adequate economic, political, practical and community support for breastfeeding—spanning from the institution of much better maternity leave policies to more family-friendly workplace arrangements—many mothers will continue to face a variety of obstacles that make conforming to ideal breastfeeding practices extremely challenging at best.

Read about how this Grad Student’s Project Educated Health Care Professionals on Extended Nursing

Though these barriers certainly require redress if exclusive and full-term breastfeeding is to become more common, providing better maternity leave by itself may not necessarily translate into major improvements. If one looks at the Canadian situation in which maternity leave policies are a good deal better, the numbers are almost as dismal. At three months postpartum, less than half of Canadian mothers are exclusively breastfeeding, and by six months, only 14% are offering nothing but breast milk. At 12 months, about a quarter of Canadian infants are receiving some breast milk, a number only marginally better than the U.S. figures.

It seems, therefore, that something else must also be afoot. As Small and others have pointed out, underpinning these very real structural barriers to breastfeeding is a belief system that is fundamentally at odds with the biological imperatives of infant and child development. In a culture in which independence and autonomy are so highly prized that infants as young as a few months are expected to self-soothe, parents are all too frequently made to feel conflicted about responding to the cues of their infants.

This rather peculiar state of affairs has unfortunately also led to the abandonment of a host of practices that have historically been integral to exclusive and full-term breastfeeding. Regrettably, many of the practices that have traditionally helped to ensure the success of the breastfeeding relationship have become marginalized and, in some cases, even vilified in the West.

The practice of cosleeping—which had been the norm throughout most of human history and continues to be in much of the world today—though never fully eradicated, was until very recently effectively forced underground by a campaign of misinformation.  Practices such as cosleeping, babywearing and comfort nursing (soothing baby with the breast instead of a breast substitute such as a pacifier or bottle), to name just a few, support breastfeeding by allowing for unrestricted access to the breast. Unrestricted access encourages a mother’s milk production and ensures a healthy feedback loop. Unrestricted access is, however, precisely that which is so often lacking today.

In sum, the abandonment of practices that support breastfeeding necessarily hampers the effect of even the most progressive policy initiatives on the ground. Simply declaring the importance and sanctity of the breastfeeding relationship, however vociferously, will have very little effect in a society that in actual fact values, and even incentivizes, mother-infant separation from an early age.  Unfortunately, we live in a time in which mainstream culture sanctions by both word and deed an approach to parenting that is totally out of sync with the needs of our children. As such, the hyperbolic reactions generated by images of older babies breastfeeding and the dire state of actual breastfeeding practices are together merely twin symbols of the very widespread misunderstanding of the attachment relationship and of infant development more generally.

The fact remains that while educational initiatives and institutional changes may help to increase breastfeeding initiation among new mothers, without a fairly dramatic re-evaluation of our current beliefs, practices, values and priorities surrounding infant and child care at large, exclusive and full-term breastfeeding will continue to be a practice of only a minority.