Posted by: Diana Cassar-Uhl, MPH, IBCLC | February 17, 2011

The opposite of normal


You’re trying to not like me.  You’re mad at me because I’m calling breastfeeding normal, and you didn’t breastfeed.  Or you breastfed for awhile, it got complicated, so you weaned to artificial baby milk.  Or you pumped your milk and fed it to your baby in a bottle, which wasn’t actually breastfeeding but was human milk feeding and why do we have to split hairs here?

And you think I’m calling your behavior abnormal, because that’s the opposite of normal, right?  Abnormal.  Irregular. Odd.  Strange.  Defective.  Freak. It’s a slippery slope, isn’t it, when we want to call one behavior normal but there are all these nice, smart, loving people who don’t do that behavior … so what do we do?

What if we called those other behaviors alternative?  We have normal, and we have alternative.  Dictionary.com gives us 3 noun and 4 adjective definitions for this word.  Let’s work with this noun:

one of the things, propositions, or courses of action that can be chosen

… and  let’s call this our adjective:

employing or following nontraditional or unconventional ideas, methods, etc.; existing outside the establishment

So, we call breastfeeding the norm (normal) because biologically, it’s the next step for a mammal that gives birth to a baby, and we can call artificially feeding the alternative because it’s another thing, proposition, or course of action that can be chosen.  Now, when we describe breastfeeding, we’re still left with normal, because it’s still … well, normal.  Except, here in the United States, it isn’t culturally normal.  Go ahead, click on that link to the Centers for Disease Control and take a look.  Less than half?  Not exactly commonplace.  Run-of-the-mill.  Conventional.  Prevalent.  Standard.  Normal? And yet, the alternative, the option that supposedly follows nontraditional ideas, methods, etc. and exists outside of the establishment … that’s the behavior adopted by the pretty significant percentage of mothers and their babies (and yes, I see that data is a few years old, but I’m willing to put it out there in light of how relatively steady those numbers stayed over an 8-year period and of how similar the experiences mothers share with me are to the ones I was hearing about 4 years ago).

Does anyone else think this is kind of backwards?

Artificial infant feeding is an alternative.  It’s a viable choice when normal isn’t possible or when normal isn’t ideal.  And, while breastfeeding is most definitely normal, and, from the point of view of the baby, ideal, our culture has some improvements to make before breastfeeding feels ideal to every mother.  So we have alternatives.

The World Health Organization places breastfeeding as the optimal way for a baby to be fed, stating:

Breastfeeding is an unequalled way of providing ideal food for the healthy growth and development of infants; it is also an integral part of the reproductive process with important implications for the health of mothers. As a global public health recommendation, infants should be exclusively breastfed for the first six months of life to achieve optimal growth, development and health. Thereafter, to meet their evolving nutritional requirements, infants should receive nutritionally adequate and safe complementary foods while breastfeeding continues for up to two years of age or beyond. Exclusive breastfeeding from birth is possible except for a few medical conditions, and unrestricted exclusive breastfeeding results in ample milk production.

(OK … wait!  Did you read that right?  This part:

while breastfeeding continues for up to two years of age or beyond

I guess I’ll have to write about that in another post!)

The World Health Organization, in its global strategy on infant and young child feeding, recommends viable alternatives when breastfeeding is not possible/chosen.  In order of biological normality, these are the World Health Organization’s recommendations for infant feeding:

  1. mother’s milk from mother’s breast
  2. mother’s milk fed through an alternate vessel (cup, dropper … bottle is last on the list because of safety/hygiene issues in some countries)
  3. milk from another healthy mother/wet nurse/donor
  4. artificial baby milk

Clearly, this is not the picture we see here in the United States, although organizations such as MilkShare and HumanMilk4HumanBabies are, of late, emerging from the hidden “counterculture” of mothers who provide their milk for other babies.  I’ve spent a long time trying to figure out where we’ve gone wrong as a culture, and I’m realizing the answer to that question is multi-layered and involves a web of money trails, myths, cultural gainsays that have penetrated our concept of what bodies are for, and so many other factors — but this answer does nothing to get us out of this hole.  We can’t untangle the mess that’s been made, we have to start over and reclaim our concept of normal. We can keep our safe, viable alternatives for those who need them, but the time has come to re-establish the normality our culture has allowed to slip through its very fingers.

Want to read more about this?  Check out Jessica, The Leaky B@@b’s blog post about how we can speak truthfully about infant feeding without slinging mud.

A Translation Guide for Navigating the Terrain Between Breastfeeders and Formula-Feeders

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Responses

  1. Hi Diana! Great blog.

    Even though my baby was born in 2001, this is still a topic I feel very strong about. I breastfed my son until he was 16 months old, and am proud to this day to be able to say that! My original plan was to nurse until 2 years old, but I had to go on a medication that required me to wean. I weaned very gently, putting off the medication until my baby was fully weaned. I didn’t force him to stop cold turkey, so it took about 6 weeks for me to go from 2 feedings a day down to zero.

    In all the time I was nursing, the worst part about it all was that he wouldn’t take breastmilk any way except nursing – no bottles, no sippy cups, nothing. There were, I admit, times I felt tethered to this baby, but it was such a short time of my life that I was willing to stick with it & do what I felt was best for him.

    I heard all the usual resistance from older women in my family, friends, colleagues, but it all fell on deaf ears. Breastfeeding seemed so normal to me, so essential to the whole process, that nothing was going to stop me.

    I’m glad to continue to sing the praises of breastfeeding & to share my stories with anyone interested enough to listen!

  2. Thanks for sharing your story, Lisa! And it’s terrific to hear that breastfeeding your baby, while it was complicated at times, remains a really satisfying memory for you. I also had breast-only babies, which definitely surprised me, but forced me to think outside the box, which ended up being optimal for my babies and for me (even if I didn’t embrace that at the time). Many mothers can’t or don’t consider “outside the box” and that’s what I hope to help change — making it as culturally easy to do what’s normal as it is to choose an alternative.

  3. Hi Diana! Speaking about the opposite of normal, that’s kind of how I feel. :) I have self diagnosed myself as having Insufficient Glandular Tissue (because my doctor and midwife only know what I have told them) and loved the podcast interview that you did on that topic.

    I have done EVERYTHING possible to produce enough milk for my babies, but can only produce about 70% and use an SNS to supplement the rest. I am now 12 weeks pregnant with baby number 6 and was wondering if you have any info on progesterone treatment during pregnancy. Can goats rue be taken during pregnancy?

    Thank you for your dedication to breast feeding moms. :)

    • Hello, dear one,

      You are definitely not the “opposite” of normal, you are a “variation” of normal. Big difference! :)

      Baby number six! Wow! Have you found you make more milk for each subsequent baby? 70% is quite good. Progesterone in pregnancy can be beneficial to mothers who have low progesterone in the first place, usually marked by luteal phase defect (short luteal phase, between ovulation and period starting) — but it’s usually taken in the first trimester, which you are coming out of now. Goat’s rue, as I’ve read, can be taken in pregnancy but may be most effective toward the end of pregnancy.

      Have you read Diana West and Lisa Marasco’s book “Making More Milk?” Lots of great information there, as well as on the website http://lowmilksupply.org .

      I’m excited to have two opportunities to speak about hypoplasia/IGT in 2012 — getting our healthcare providers educated about this topic is vital so moms like you can get the information you need. Feel free to share my podcast as well as the article I wrote on supporting mothers with mammary hypoplasia for La Leche League International (it’s on my resource list, let me know if you can’t find it).

      –Diana

      • Thanks so much for your informative reply! I found that I had more milk with baby number 2 than my first child, but I’m not sure if there was improvement after that. My third and fourth were twins and I was supplementing with a bottle because I hadn’t yet heard of the SNS. I was heartbroken when they perferred the bottle and only nursed them for 9 months. My fifth benefitted from the SNS and I finally discovered the problem (IGT)!

        I think that I do have a luteal phase defect. I was charting and didn’t even think that I was ovulating because there wasn’t a significant rise and my temp continued to rise and fall even after it did seem to rise somewhat. I entered the info into a computer program that said that I did ovulate and that my luteal phase was 11-12 days which I think is short.

        Thanks for the great resources. I will definately share the info with my doctor, midwife and others.

        I’m so glad that you are getting the word out. I went too many years not knowing what was wrong and feeling like a failure. I don’t want other women to go through the same pain. Your friend is so blessed to have you take such interest and do so much work to find a solution.

        Blessings,
        Rachel

  4. DIana, thank you so much for your research on IGT. I was diagnosed at 3 days postpartum with my first baby. She was born in mid July shortly before your podcast re: IGT.

    I had 2 miscarriages prior to that pregnancy and was put on progesterone suppositories at week 5 which is what I think saved the pregnancy. I am hoping that starting progesterone earlier in my next pregnancy might produce more breast tissue. I found this article & it has given me hope: http://jhl.sagepub.com/content/15/4/339.abstract%C2%A0 Do you think this is an isolated success story or have you heard of other cases where progesterone helped a woman with IGT reach a full supply?

    I’m truly inspired by your friend Heather. Through an SNS/herbs/domperidone/pumping I have been able to breastfeed my now 4 month old who is now enjoying grasping at the tubes. :-/

    My mother was a LLL leader & successfully & easily exclusively breastfed my siblings & I. I never fathomed that I’d have any difficulties breastfeeding but I still set myself up for a great start to breastfeeding, I had a homebirth with immediate skin to skin. Baby had a great latch and sucked well.

    I experienced a retained placenta that was manually extracted at home and for weeks, I hoped & prayed that I was still retaining some of my placenta to explain my lack of milk.

    Some days are so difficult, I have asked myself countless times “why am i still doing this?!?!” (using the sns). But the other day on Mobi’s site, I read “Don’t quit on your worst day”. That statement really spoke to me.

    Do you mind sharing what kind of an milk increase Heather experienced with her 2nd baby? And what herbs she found most helpful? One thing that keeps me going is that supposedly any breastfeeding you do sets you up for better success with future babies. I had heard/read this multiple times but I’ve not read any research on this. Is there documented research to backup the claim that breastfeeding with an SNS will help my supply with the next baby?

    Thank you!

  5. Hello Claire! Thanks for your comment.

    I’m thankful you shared your story and of course glad to hear you got a quick diagnosis as well as good support.

    The journal article you cited above is a case report that gets a lot of attention. While most mothers I’ve worked with have noticed an increase in milk production with subsequent babies, it’s difficult to know whether supplemental progesterone or other measures were most effective (or effective at all), because the mothers who’ve shared experiences with me, understandably, try every avenue to maximize milk production once they know IGT is an issue for them. Other measures I’ve heard about include goat’s rue in pregnancy (talk with your doctor or someone experienced with herbs — there are reasons this might not be appropriate for certain individuals or even effective depending on the reason for the low milk production), significant weight loss in women with PCOS (diagnosed or undiagnosed), use of glucophage/metformin in pregnancy (also a PCOS issue), dietary changes, the list goes on. And, even mothers who never experienced low milk production report more milk with each subsequent baby (myself included).

    It’s difficult to report a specific difference in milk production between babies because each baby is different in feeding patterns, anatomy, etc. … that said, Heather did find she needed less supplement with her second baby, and this was illustrated best by her ability to breastfeed part of the day without “the rig” (her supplementer) and use it during other times of the day (such as at naptime and bedtime). Her two babies had different tolerances for solid foods, as well, which also changed the number of calories that were being demanded from breastmilk and supplement.

    I’m very happy to hear that you have been helped by the work I’ve done about this topic — I’m very hopeful to gather some more data and get it out there so we reach more mothers and healthcare providers. I encourage you to hang in there — I think about my own experience with my three babies, and I can say that while milk production was not my problem, there were lots of “bad days” related to the issues we did have. Your “don’t quit on your worst day” mantra is a terrific one; I found a lot of peace in the thought that breastfeeding and mothering isn’t “perfect” or “easy” for any mother — we all have something to face at some point (for me, it was a too-soon return to work and the ensuing juggling act to make sure my babies got what they needed from me). I’m sure your mother has told you that LLL is a great place to find support and your presence and story will inspire many moms in the moments when they struggle.

    Thank you again for taking the time to comment on my blog, and I wish you continued success in breastfeeding.

    –Diana

  6. [...] started my blog with the goal of normalizing breastfeeding in American culture.  I defined normal, and contrasted it against the alternatives.  I also acknowledged that, even in the absence of barriers, some can’t and some don’t [...]


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