Breastfeeding beyond babyhood
Breast is best - but is there an age where breastfeeding
becomes too much of a good thing? Sadie Morgan takes a look at
extended breastfeeding.
The length of time for which a child is breastfed is
a very personal decision, yet fraught with controversy. Daytime
talk shows and prime-time "documentaries" (like the recent episode
of Real Life on TV One entitled "Honey, I Suckled the Kids") paint
extended breastfeeding as a subculture rather than the norm; even
the show's description (which also discusses attachment parenting,
the use of baby slings, and cosleeping) on the TV One website
says, "Sitting to the extreme right and left of the
conventional parenting spectrum, so taboo are some of these
practices that some parents have gone underground to avoid being
judged." Going underground to avoid judgement on how you feed your
child - now there's a comforting thought.
The World Health Organization (WHO) recommends that
"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." However, despite these recommendations,
"No more than 35% of infants worldwide are exclusively breastfed
during the first four months of life; complementary feeding
frequently begins too early or too late, and foods are often
nutritionally inadequate and unsafe." Furthermore, WHO's own data
shows that by the age of two years, only 20% of children are still
receiving breastmilk. That means that 80% of children are not
being breastfed in line with worldwide standards.
Why don't more women breastfeed their children for extended
periods of time? And for those women who do practice extended
breastfeeding, what's it really like?
The right start
Breastfeeding is a natural act, and one that the female
body is designed to do following the birth of a child.
However, it is a practice that must be learned, and doesn't
necessarily "come naturally" to women. Contemporary New Zealand
mothers are giving birth to their first children in a culture where
large families are no longer the norm. Instead of growing up
surrounded by relatives and helping care for younger siblings and
cousins, families are smaller and more far-flung. There is little
opportunity for first-time mums-to-be to observe other females
breastfeeding their children; to absorb this practice into their
own psyches and know, without question, that they will
undoubtedly feed their own babies this way. Instead,
breastfeeding has become a subject that is "either/or", with
women thinking, "Well, if I can't breastfeed, I'll just
formula-feed." The trouble is, when it comes down to whether a
woman "can" or "can't" breastfeed, anecdotal evidence suggests that
society is still not giving women enough support, either with
breastfeeding or with formula-feeding.
As WHO asserts, "Virtually all mothers can
breastfeed, provided they have accurate information, and support
within their families and communities, and from the health care
system. They should also have access to skilled practical help
from, for example, trained health workers, lay and peer
counsellors, and certified lactation consultants, who can help to
build mothers' confidence, improve feeding technique, and prevent
or resolve breastfeeding problems."
But who among your friends was lucky
enough to have all of this incredible support? For most mothers in
New Zealand, three days in hospital is the longest they'll get, and
for many mothers of newborns, by the time they leave hospital,
their milk hasn't even come in. The need for support comes weeks
later, in the middle of the night, when they're sleep-deprived and
hormonal, trying to latch a screaming baby onto a sore nipple. It's
no wonder only 35% of infants worldwide are exclusively breastfed
for the first four months of life. Many mothers can't see the
benefit of breastfeeding for longer when their immediate experience
is of pain, confusion, and the feeling of being "over
it".
Making it work
For women who do breastfeed for extended periods of time, there
seems to be a societal "cutoff point" that occurs when their babies
are around one year of age. This is the time when friends, family,
and even perfect strangers start making comments and enquiring as
to when the child is going to wean.
Claire Andrews, who is the mother of a
23-month-old boy, and also pregnant with her second child, has
experienced this firsthand. She gave birth to her son, Marcus, with
the intention of breastfeeding him for as long as he wanted to
be fed. But she felt like an outsider in her antenatal group,
and as her son got older and continued to breastfeed, she felt
more and more marginalised.
"I think I started to notice a difference
around the six-week mark. Other mums in my antenatal group were
starting to express breastmilk so they could have a break, and I
wasn't. Also, the others were trying to get their babies into a
feeding routine rather than demand-feeding. I always just fed
Marcus whenever he wanted it, regardless of how long ago I'd fed
him. I didn't worry about the clock. I never had a problem with
supply, as Marcus was fed a lot, so my body just made what he
needed.
"When the other babies in antenatal group
started to bite, a few of their mothers weaned them right
away, whereas I put a lot of effort into teaching Marcus not
to bite me. I really noticed how different I was when Marcus got to
a year old, and I only knew two people outside of La Leche League
who were still breastfeeding. It was a very lonely feeling when the
last person in my antenatal group weaned her child. I felt like I
was a freak."
Despite initial misgivings, Claire joined
her local La Leche League group, and quickly realised that she was
not only accepted without judgement, she was treated as though
there was absolutely nothing abnormal about breastfeeding a toddler
- which was a huge change from what she'd experienced with her
antenatal group, and even within her own family.
"It's amazing what people will say about
breastfeeding when they don't even know you. One of the most
difficult things for me to contend with was the lack of support
from my parents with regards to breastfeeding. Soon after Marcus
was born, my father called to tell me that a customer of his
workplace, who'd had a baby a few weeks before I did, kept
telling him how wonderful it was that her baby was sleeping through
the night - and he was on formula. Every time she'd come into his
workplace, she'd tell him about the formula, and Dad would ring me
up afterwards with the details of the formula so I could get it for
Marcus. My mother even called to tell me that I was weaned at
three months because I cried too much, and that I should wean
Marcus, as he was obviously crying out of hunger and needed more
than my milk to help him sleep."
Shocked, Claire turned to the La Leche
League and parenting books for information and advice, but quickly
realised that the messages she was hearing were conflicting. "All
through antenatal classes, and in all the parenting books I read,
breastfeeding was clearly the best decision for both mother and
child. I thought that everyone agreed on this. But it turned out
that despite what I was reading about the benefits of persevering
with
breastfeeding, society still looks at breastfeeding as something
that should have a time limit on it."
Benefits of extended
breastfeeding
Breastfeeding a child for a length of time has been
shown to have significant health advantages for both the mother and
child.
The La Leche League International states,
"All the benefits of human milk - including nutritional and health
- continue for as long as your baby receives your milk. In fact, as
your baby takes less human milk, these advantages are condensed
into what milk is produced. Many of the health benefits of human
milk are dose-related; that is, the longer the baby receives human
milk, the greater are the benefits."
Recent studies confirm that breastfeeding
for a longer time actually imparts greater benefits to the
breastfed child. Children who are breastfed for a significant
period of time:
• Have a reduced risk of obesity in later life.
• Have improved cognitive development and performance in
childhood.
• Have higher IQs than those children breastfed for
less than seven months.
• Have a significantly lower risk for cardiovascular
disease.
• Have a lower risk of respiratory infections such as
pneumonia and otitis media (glue ear).
But not only is extended breastfeeding beneficial for the child,
it's also beneficial for the mother. Mothers who breastfeed their
children for an extended period of time:
• Have a decreased risk of breast cancer, ovarian cancer,
uterine cancer, and endometrial cancer.
• Are more protected against hip fractures and
osteoporosis in the postmenopausal period.
• Have a reduction in the likelihood of later
development of Type 2 diabetes (this reduction is greater with
each year of breastfeeding).
• Have a reduced risk of developing rheumatoid
arthritis.
Claire explains, "Knowing that I'm doing all that I can to set
Marcus up for life, healthwise, is extremely important to me.
Breastfeeding is so easy (once established and learned),
yet the benefits are incalculable, both in terms of health and
emotional development."
Breastfed toddler = 'Mummy's
boy'?
The health benefits of extended breastfeeding are clear, but this
doesn't seem to be what society has the biggest problem with. For
many people, the thought of a toddler being breastfed is appalling,
and fears for breasfed toddlers' social and emotional development
are rife. "When he's old enough to ask for it, he's old enough to
be weaned!" seems to be the pervading sentiment among mothers who
are breastfeeding.
Yet research shows extended breastfeeding
does not have a detrimental effect on the social, emotional,
or psychological adjustment of a child. In her article "Nursing
Beyond One Year", Sally Kneidel explains, "Research reports on the
psychological aspects of nursing are scarce. One study that dealt
specifically with babies nursed longer than a year showed a
significant link between the duration of nursing and mothers' and
teachers' ratings of social adjustment in six- to eight-year-old
children (Ferguson et al, 1987). In the words of the researchers,
'There are statistically significant tendencies for conduct
disorder scores to decline with increasing duration of
breastfeeding.'"
According to Katherine Dettwyler, PhD, "In
societies where children are allowed to nurse 'as long as they
want', they usually self-wean, with no arguments or emotional
trauma, between three and four years of age."
Additionally, research into natural
weaning age by Dettwyler has found that "human children are
designed to receive all of the benefits of breast milk and
breastfeeding for an absolute minimum of two and a half years, and
an apparent upper limit of around seven years."
But in choosing to allow a child to
breastfeed for "as long as he wants", is the mother creating an
unhealthy dependency between herself and her child? Children need
their mothers - we're the only species on the planet born
completely and utterly helpless, and without our mothers' help, we
wouldn't survive. Children are inherently dependent on their
mothers, and independence cannot be rushed. Children need to
achieve independence at their own pace in a secure, loving
environment where they are safe in the knowledge that someone is
looking after their needs. This kind of self-led independence, once
attained, is more secure than if children are forced into
independence prematurely. As Elizabeth Baldwin explains in her
article "Extended Breastfeeding and the Law", "Meeting a
child's dependency needs is the key to helping that child achieve
independence. And children outgrow these needs according to their
own unique timetable."
Milk for two?
Tandem breastfeeding is another cultural taboo, and one that's
misunderstood. "How can one woman have enough milk for two babies?"
is the most commonly asked question, but research - and experience
- prove that the female body is capable of making enough milk for
multiple infants. Many women wean their breastfeeding children
in order to get pregnant with another child, or because they have
recently learned they are pregnant again. But it's possible to keep
breastfeeding through pregnancy and beyond.
For Claire, who is pregnant with her
second child and still breastfeeding Marcus, it has not been easy -
but she has persevered. "At the beginning of this pregnancy, it was
awful. My nipples hurt, and I was so exhausted that I would
often sit down to feed Marcus and just cry. When I was about three
months pregnant, I got mastitis for the first time. During that
time, it was so awful feeding Marcus, as it was so painful. But
breastfeeding was the only thing that helped. Because of the change
in the flavour of my milk due to the infection, Marcus wasn't that
keen to feed, which stressed me out and made the mastitis hurt
more. But talking to one of my La Leche League leaders helped me to
calm down and not put so much pressure on Marcus to nurse, which
led to our stress levels reducing, and he gradually started
breastfeeding again.
"About a month after the mastitis cleared
up, Marcus started dropping feeds, which really upset me. I felt
like such a failure and dreaded feeding times, in case Marcus
turned me down. But again, I talked to one of my La Leche League
leaders about the situation, and just allowed Marcus to lead the
way. Soon he was feeding again, and even went to four feeds a day
when he had only been having three feeds a day for a few
months.
"When my third trimester started, the
dreaded sore nipples returned, and my milk supply dropped. For a
long time, I was sure that Marcus wasn't getting anything, and was
more or less just nursing for comfort. But then he started feeding
for longer periods of time. Sometimes I have to tell him, 'Just one
more minute!' and then take him off, as my nipples hurt too
much.
"For a while in the middle of my
pregnancy, Marcus's weight on my bump would make me feel sick. Even
with him supported by a pillow, the weight on my stomach was too
much. But that phase was soon over, and it hasn't been a problem
since."
Indeed, as the La Leche League
International says of breastfeeding while pregnant and tandem
breastfeeding, "Some mothers express concern that their toddler may
be taking milk meant to nourish their baby. These mothers may take
comfort in the fact that breasts are marvellous things that can
adjust their production to meet the demands placed upon them - if
they are asked to produce enough milk for two, they usually can!
Also, most toddlers breastfeed considerably less frequently than an
infant, and get most of their nutrition from other foods."
Supporting extended breastfeeding
"It would really help me to feel encouraged to keep breastfeeding
if society would stop looking at me like I'm a weirdo," Claire
says. "I am doing the best for my child, and I want people to
recognise and respect that."
For women who breastfeed their babies
longer than the "norm", the feeling of being somehow separate from
polite society is incredibly upsetting - and so it should be.
Breastfeeding is normal and natural, and its beneits are
evident.
As Claire explains, "Right from Marcus's
birth I've set breastfeeding goals. First it was just to get
through one feed, as it was so hard to get him started. He was
severely tongue-tied, and from birth I was told he wouldn't be able
to breastfeed, but we did it. Once we got past one feed, my goal
was six weeks, than six months, then a year, and then two years. I
have no goal past two years. I really want Marcus to wean himself
when he is emotionally ready. If you had asked me even a year ago
if I would still be breastfeeding at 23 months, I would have said,
'Probably not.' Now we will just have to see what happens. I'm in
no hurry for Marcus to wean himself, as I love the intimacy of
breastfeeding, and I know that every drop of milk Marcus gets
from me is beneficial to him."
What is the one thing Claire would love
people to stop commenting on? "When people ask me, 'Are you still
feeding him?' I get really annoyed. I always want to reply, 'Oh,
bugger, I knew there was something I forgot to do.' Society doesn't
own my breasts, so I want people to stop acting as though they
have a right to tell me what I should or should not be doing
with them."
References and support
• American Academy of Pediatrics.
"Policy: Breastfeeding and the Use of Human Milk."
http://aappolicy.aappublications.org/cgi/content/full/pediatrics;115/2/496
• Baldwin, EN. "Extended Breastfeeding and the Law."
Mothering, Spring 1993.
• Bonyata, Kelly. "Extended Breastfeeding Fact
Sheet."
www.kellymom.com/bf/bfextended/ebf-beneits.html
• Bumgarner, Norma Jane. Mothering Your Nursing Toddler. La
Leche League International, 2000.
• Dettwyler, Katherine. "A Natural Age of Weaning." www.kathydettwyler.org/detwean.html
• Dettwyler Katherine. "A Time to Wean." Breastfeeding
Abstracts 14. 1 (August 1994): 3-4.
• Ferguson DM, et al. "Breastfeeding and subsequent social
adjustment in six- to eight-year-old children." The Journal
of Child Psychology and Psychiatry and Allied Disciplines Vol 28
(1987):378-86.
• Flower, Hilary. Adventures in Tandem Nursing: Breastfeeding
during Pregnancy and Beyond. La Leche League International,
2003.
• Harmon-Jones, Cindy. "Duration, Intensity, and Exclusivity
of breastfeeding: Recent Research Confirms the Importance of
these Variables." Breastfeeding Abstracts 25.3 (May 2006):
17-20.
• Kneidel, Sally. "Nursing Beyond One Year." New Beginnings
6.4 (July-August 1990): 99-103.
• La Leche League International. "How long should a mother
breastfeed?" www.llli.org/FAQ/blength.html
• La Leche League International. "Is It Possible to
Breastfeed Both an Infant and a Toddler?" www.llli.org/FAQ/tandem.html
• La Leche League International. The Womanly Art of
Breastfeeding. La Leche League International, 2004.
• La Leche League New Zealand. www.lalecheleague.org.nz
• "Real Life: Honey, I Suckled the Kids." http://tvnz.co.nz/view/page/413551/1877231
• Warner, Bronwyn. "Breastfeeding through Pregnancy and
Beyond."
www.breastfeeding.asn.au/binfo/tandem.html
• World Health Organization, 2003. "Global strategy for
infant and young child feeding."
• World Health Organization. "Indicators for assessing infant
and young child feeding practices: Conclusions of a consensus
meeting Washington D.C., USA, 6-8 November 2007."
www.who.int/nutrition/publications/iycf_indicators_for_peer_review.pdf
As seen in OHbaby!
magazine Issue 3: 2008
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