Breast of Burden

The pump. The poop. The panic. A dispatch from the nursing wars.

But don't kid yourself; an equal measure of the rationale for declaring this private decision open to public scrutiny is ideological. Reports Blum: "A group of women I spoke to this year said, 'Why isn't [breastfeeding] just one of the many different parenting decisions we'll have to make? Why does it take on this moral cast that if you're going to be a good mother, this is what you're going to do?' This one, at least in our culture, has a lot packed into it."

As far as I can tell, it's been this way for a long time. Although breast milk has almost always been regarded as "perfect," there have been alternatives to nursing your infant for hundreds of years. Centuries ago, the least fortunate babies were given "paps," or mixtures of animal milks, flour, sugar, water, even tea. But until about the 1920s, when clean water became widely available, "artificial" milk was often linked with higher infant-mortality rates, and generally seen as a last resort.

More privileged babies whose mamas couldn't or didn't want to put them to the breast were turned over to a wet nurse. "There was this idea that if a woman were sexually active, her milk could harm or even kill her child," explains Blum. And because breastfeeding often suppresses ovulation, it was anathema to aristocratic women under pressure to produce male heirs.

In colonial America, by contrast, nursing was thought to guarantee robust babies. The practice was considered a woman's "patriotic duty," Blum says. In the 1800s, breastfeeding was considered a matter of medical necessity, and women who needed a wet nurse would ask their doctor to find one. The ideal candidate, Blum notes, was "a good, sturdy farm wife," preferably white.

As it happened, it was often far more convenient to turn the job over to a black slave: Although research into the practice has generated a good deal of controversy, it's generally thought that 20 percent of slave owners used slave wet nurses. As late as the 1920s white mothers commonly hired black women to nurse their children.

Even after advances in sanitation made formula-feeding less hazardous, doctors recognized breast milk as superior and sought ways to make it possible for more women to nurse. In 1919 Julius Parker Sedgwick, chief of the Department of Pediatrics at the University of Minnesota, set out to increase the rate of breastfeeding among Minneapolis mothers. A longtime proponent of the health benefits of nursing, Sedgwick often passed a beaker of human milk in the classroom for his students to taste. He convinced private physicians as well as the city's Department of Public Health and its Infant Welfare Society, to help him keep in touch with every woman in the city for nine months after the birth of her baby. To this end, Public Health nurses called or visited new mothers--daily, if need be--to help out.

"The personal attention and follow-up paid off," the Journal of Human Lactation reported last year, listing some statistics today's pediatricians can only dream of. "According to mothers' and nurses' reports, more than 96 percent of babies born in Minneapolis during the first five months of 1919 were still breastfeeding at the end of their second month. More than 72 percent were still breastfeeding at the end of their ninth month." Infant mortality, the article went on, dropped 20 percent during that time. The effort was disbanded by 1926 because of a lack of funding. Today, most insurance companies won't so much as pay for a visit with a lactation consultant once a mother has been discharged from the hospital.

But even as Sedgwick conducted his campaign, more and more doctors began to equate formula with progress. "Physicians worried that 'civilized' mothers who lived under unnatural strains and 'had highly developed nervous systems,' were less suited to nursing," Blum writes. Doctors "emphasized the need to avoid becoming nervous, overwrought, or overcome with 'fright, fatigue, grief, or passion.'"

Frequently overwrought by pretty much everything, my grandmother raised both my mother and my uncle on the bottle, a decision I hear she never once considered having to justify. At the time, formula companies were becoming ever more market-savvy: They began sponsoring medical research and distributing samples in maternity wards. By the time my mother was contemplating babies, formula was thought to be actually superior to breast milk. (She never literally faced this decision, since my brother and I were adopted.)

In the 1970s, a decade after my birth, women were joining consciousness-raising groups in droves, and flocking to bookstores to buy copies of Our Bodies, Ourselves. The breast was back, baby, and it was beautiful. (So, by the way, was cold, dark beer--often recommended to improve milk supply. In contrast, the most popular mommy manual out there today, What to Expect the First Year, not only frowns on alcohol consumption by nursing mothers, it lists a whole host of reasons why even women who aren't breastfeeding should refrain from drinking.)

This return to the breast was helped along by efforts to draw attention to dangerous formula-marketing efforts in the Third World. The free samples from the hospital, it was argued, suggested that formula was superior to anything a woman's own body could produce--or, perhaps, simply tempting new parents to pop open the can during that harrowing first night home. Once Mama's milk had dried up and the samples run out, poor families would have to resort to mixing up bottles using too little of the powder and, sometimes, contaminated water.

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