Breastfeeding on the move – literally

photo of woman's legs wearing shorts and hiking bootsI’m a great advocate of the right to breastfeed in public places and get extremely annoyed with people who express their ‘distaste’ at the idea. How ludicrous to deny babies the right to eat outside the house, when it’s fine for everyone else? Nevertheless, with my first daughter it was something I found difficult, so I tended to avoid it if I could.

After my second daughter, A, was born, the issue of breastfeeding away from home didn’t arise for some time. Most of our trips were short, and when they did extend beyond a couple of hours, they were usually to the homes of friends or family where I was perfectly comfortable feeding. On a trip to John Lewis, however, where I ended up sitting in the foul-smelling ‘breastfeeding area’ (right next to the ‘changing area’), rather than the cafe — where I had previously got so stressed my let-down reflex refused to kick in — I decided I really had to sort this issue out.

Although I had taken the first step of realising I had a problem, I made no real effort to confront my fears, and continued to avoid breastfeeding away from home as much as I feasibly could. It’s impossible to predict the appetite of a small baby all the time, however, and when I was walking through a wet field several miles from home, the inevitable happened.

The day had started with pretty miserable weather, but by lunchtime the clouds had cleared and we set out on a 2 hour walk through the countryside confident that we wouldn’t get rained on. I had put A in a Baby Bjorn carrier, and as usual, she went to sleep the minute she was ouside. Just as we had reached the point where we were as far away from the house as we could possibly get, A woke up and started to grizzle. This was something that happened from time to time when we were out, and I carried on walking, thinking that she would just go back to sleep as she normally did.

Unfortunately, she didn’t nod off again. Instead she started to howl furiously, in the way she might if she was hungry. Despite the fact that she had been fed just before we left the house, the intervening hour had been enough to work up a hearty appetite again, and it was pretty clear that I was going to have to find a way of getting some milk down her.

This was easier said than done. I looked around for somewhere to perch, and could see nothing but mud and wet grass. How on earth was I going to get A out of the carrier and successfully latched on whilst standing up, and what was I going to do with the carrier? Then I looked down and noticed that A’s mouth was at roughly the same level as my nipple. I had previously complained about the lack of a vomit/drool barrier between A’s mouth and my chest when using this carrier (as opposed to my previous Chicco one), but now I realised this could be an advantage. After a bit of grappling with the numerous layers I was wearing, I managed to expose enough nipple for A to take into her mouth (which she did, quickly). The whole manouveure was significantly more discreet than it sounds, as most of it was shielded from view by the carrier’s head rest.

I didn’t fancy spending the next twenty minutes standing in the middle of a field (other walkers had nodded politely as they passed, but probably wondered what on earth I was doing), so I took a few tentative steps whilst trying to keep A attached. Providing I did it slowly, walking didn’t seem to disrupt her, and I managed to reach a more plausible resting spot.

I’m now quite happy to take A out in the carrier, knowing I can feed her pretty easily if I need to. Interestingly, the confidence I’ve developed through doing this has automatically extended to other situations, and I recently managed to nurse A through an entire wedding breakfast. Psychologically this was quite an achievement for me, as I knew some of the guests weren’t keen on breastfeeding (‘I was bottle fed and it didn’t do me any harm’ etc.), and I had been dreading the prospect of constantly heading to the loo with a hungry baby. In the end, I just stayed at the table and got on with it. I can’t say the experience was wonderful, but that was mainly because I was sitting on a less than comfortable chair and had to negotiate the meal one-handed. Perhaps not surprisingly, breastfeeding in the John Lewis cafe holds no fear for me now.

Breastfeeding in public: is nine months really the end of the road?

bibAlthough the NHS recommend breastfeeding for at least a year, and the World Health Organization for two years and beyond, I’m well aware that Western culture doesn’t really allow for this. Thanks possibly to hard-line health awareness campaigns, it now seems generally acceptable to be seen feeding very little babies in public, but it’s also still acceptable for people to vociferously object to anyone breastfeeding an older child. Gauging the point at which breastfeeding goes from ‘good’ to ‘bad’ is a tricky business, however. When does your gorgeous little infant suddenly lose their innocent penchant for breast milk, and turn into an ‘older child’, apparently in danger of being psychologically damaged by continued nursing?

Many people I know have given me their opinion on breastfeeding beyond this (as yet undefined) ‘baby’ stage.

After a television programme on extended breastfeeding, a fairly inebriated friend of my husband held forth about how how unpleasant it was to see people breastfeeding children (which doesn’t entirely explain why he spent an hour watching it on television). It wasn’t clear why he held this view, but the fact he is an avid reader of such publications as The Sun, Nuts, FHM and Maxim perhaps gives some indication of his attitude towards, and personal interest in, breasts. ‘Surely it’s got to do some long term psychological damage – f*** up your attitude towards breasts,’ is an argument that is wheeled out quite frequently (as demonstrated in this discussion of Nell McAndrew’s decision to breastfeed her toddler), although interestingly, I’ve yet to hear it from a woman. It is of course possible to turn this argument on its head – in many other countries, breasts are viewed as primarily practical, rather than sexual, so if you must view these things in black and white, you could argue that this is the ‘right’ way round – but such men seem strangely unreceptive to this possibility.

The idea that a child may be negatively affected by a memory of breastfeeding is another charge that comes up quite frequently. I’ve never got to the bottom of quite why this would be the case, but it seems, again, to be to based on the premise that breasts are for grown-ups, and getting them out for children is slightly suspect.

I had a recent discussion about feeding older children with a couple of very good friends, and although a concrete age was never mentioned, the topic came up when I started to breastfeed C, who is now nine months old. Although obviously still a baby (she can’t yet walk), she is able to sit up, wave, clap and generally communicate. It’s presently quite unusual for babies in Britain to still be breastfed at this point – according to the latest Infant Feeding Survey, only 20% of mothers make it to nine months. The timing of the conversation may have been entirely coincidental, of course, and nothing to do with me giving C an afternoon snack, but I found it hard to dismiss the thought that there was a coded message in there.

I’ve since talked to my friend about this, and while she was adamant this wasn’t the case, she also admitted she has a bit of a problem with breastfeeding toddlers. When she asked me how long I was planning to feed C, I said I wasn’t sure, but I couldn’t dismiss the possibility of continuing for another few months. She understood my reasons for this, and agreed that this was, in theory, a positive thing, but it clearly wasn’t something she felt entirely comfortable with. I’m ashamed to say that it isn’t something I feel entirely comfortable with either. The idea of feeding C (behind closed doors) is lovely, but the thought of admitting to anyone that I’m ‘still’ doing it is less appealing. I am, however, convinced that this is something I have to address: it isn’t much good complaining about our society’s attitude to breastfeeding, unless I’m prepared to challenge it myself.

Can stress affect the let-down reflex?

cartoon of person with numbers flying round their headOne piece of advice you might have heard from midwives (and well-meaning friends and family), is to make sure you breastfeed in quiet and relaxing surroundings. Given the choice, this is probably what you’d opt for (who wants to feed in noisy and distracting surroundings?), but could it actually cause a problem if you’re not able to do this?

Well, there’s a possibility it could. For some time, medical evidence has existed that indicates temporary stress or distraction can interfere with the let-down, or milk ejection reflex, meaning your baby has to wait longer for milk to start flowing freely.

Normally, cues that indicate your milk will soon be required (such as your baby crying before a feed, or suckling at the start of one1) trigger the release of the hormone oxytocin, which enters the bloodstream in ‘pulses’ a few minutes apart, forcing milk to flow from the ducts and out of the nipple (see ‘Breastfeeding and Human Lactation’ by Jan Riordan for a full description of this somewhat complicated process.)

In 1948, an experiment conducted with a single breastfeeding woman indicated that distractions can inhibit the release of oxytocin, delaying the start of milk ejection2. This effect was confirmed in a more recent study, which monitored the oxytocin levels in the blood of three groups of breastfeeding mothers who had given birth five days previously3. The first group was asked to perform difficult verbal arithmetic problems whilst nursing their babies (the stress condition), the second was subjected to the noise of a building site through earphones (the noise condition) and the third breastfed without these distractions (the control group).

Oxytocin release occurred significantly later and less frequently in the noise and arithmetic groups than it did in the control group, indicating that these temporary stressors impaired the mothers’ let-down reflexes. The amount of milk the babies consumed (measured by weighing them before and after the feed) did not differ between the groups, however, so although stress affected the frequency of let-down, it did not appear to prevent babies from consuming an adequate amount of milk.

These results demonstrate that mild temporary stress, such as trying to perform difficult arithmetic problems (five days after giving birth!) or being exposed to the noise of construction work can delay the let-down reflex, both at the start of a feed, and throughout its duration. This may explain why in situations where you feel under pressure or distracted (for me, this certainly applies to feeding in public), it feels like your milk takes forever to appear – not great when you’re trying to deal with an angry baby. Fortunately, this problem doesn’t appear to affect the amount of milk your baby consumes overall, so it isn’t necessarily anything to worry about (this would probably only make it worse, after all…) Nevertheless, it is an irritation that both you and your baby would probably prefer to avoid, and therefore the perfect excuse to insist that your surroundings whilst breastfeeding are as chilled out as possible.

  1. Br Med J (Clin Res Ed). 1983 Jan 22;286(6361):257-9.
  2. J Pediatr. 1948 Dec;33(6):698-704.
  3. Obstet Gynecol. 1994 Aug;84(2):259-62
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