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.

Nipple shields: always a bad thing?

drawing of baby on scalesI have spoken to many mothers, including two midwives, who have used shields to ease nipple pain while they are breastfeeding without any apparent problems for their babies. Although they have been described (in the words of one mother) as ‘a godsend – the thing that made breastfeeding bearable for me,’ they are not recommended by the National Health Service.

What’s the problem with using nipple shields? Well, an NHS Primary Care Trust Breastfeeding Policy document cites two studies demonstrating slower milk transfer when using a shield1,2.

The trouble with this research is that it was conducted over 25 years ago, and shields have moved on in that time. A more recent study (published in 2006) test-weighed babies after feeding with or without a thin silicone shield and found that there wasn’t any difference in their milk intake3. The same article reports the results of a survey of mothers’ attitudes to using nipple shields and found evidence that they actually help to prevent early breastfeeding termination, rather than cause it. Another survey of shield use found that 86% of women utilizing them felt that they allowed them to continue breastfeeding when they might otherwise have given up4.

One study investigating the impact of a number of factors on nursing duration initially appeared to link using a nipple shield in hospital with a greater risk of discontinuing breastfeeding5. When other factors known to affect breastfeeding duration (such as the type of delivery the mother had and whether she smoked) were taken into account, however, the relationship between shield use and early weaning declined to the extent it was no longer statistically significant.

It has been suggested that using a shield from very early on could cause nipple confusion, meaning your baby wouldn’t want/be able to feed directly from the breast. An instance of this was reported in a case study more than 20 ago, which described a baby who refused to latch normally onto the breast, having been taught to attach with a rubber bottle teat covering the nipple6. This case study, which doesn’t even really demonstrate the problem – a bottle teat is quite different to a modern shield – appears to be the only recorded evidence for shield related nipple confusion. According to an article recommending shields for feeding premature babies (a situation in which they have been shown to be very useful), ‘the term “nipple/teat” confusion remains a hypothesis,’ i.e. it might be a problem, but there isn’t yet any strong evidence to support it7.

Using a nipple shield won’t necessarily be trouble-free: you have the hassle of cleaning, sterilizing and applying it before each use, not to mention remembering it when you go out. Despite these drawbacks, some mothers undoubtedly find shields very helpful. Women who choose to use them are already experiencing breastfeeding difficulties, such as nipple or latch problems, and are therefore at greater risk of stopping anyway8. When the alternative to a nipple shield is a bottle, perhaps trying one isn’t such a bad idea after all.

  1. Acta Obstet Gynecol Scand. 1987;66(1):47-51.
  2. Early Hum Dev. 1980 Dec;4(4):357-64.
  3. J Obstet Gynecol Neonatal Nurs. 2006 Mar-Apr;35(2):265-72.
  4. J Hum Lact. 1996 Dec;12(4):291-7.
  5. Midwifery. 2008 Mar;24(1):55-61.
  6. J Hum Lact. 1986 ;2(1):28-30.
  7. Infant. 2005 ;1(4):111-115.
  8. J Hum Lact. 2004 Aug;20(3):327-34.
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