Is exclusive, extended breastfeeding natural?

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One of the most disturbing things about the natural childbirth and lactivists movements is the way they treat our distant foremothers; they treat them the same way we tend to treat all people who are non-white and non-industrialized, as one mass of undifferentiated, never changing animals.

It seems to have never occurred to them that for most of 30+ thousand years prior to the advent of writing, human beings existed in discrete cultures with discrete cultural practices. They had highly advanced civilizations complete with tools, pottery, and art … as well as traditions around birth and breastfeeding.

Exclusive, extended breastfeeding is like the missionary position: just one possible choice among many natural choices.

Natural childbirth and breastfeeding advocates don’t really pay much attention to what those specific traditions are. Either they behaved like animal relying on their “instinct” (just like contemporary natural childbirth and breastfeeding advocates!) or, to the extent that their traditions differed — think belief that childbearing women were unclean or supplemented their babies with prelacteal feeds — ignorant and “uncivilized.”

Why does it matter? Because both natural childbirth advocates and lactivists are longing for a past that may have never actually existed. Practices like exclusive, extended breastfeeding may exist only in their imaginations and nowhere else.

That’s what Anthropology Prof. Jonathan Wells explains in The Role of Cultural Factors in Human Breastfeeding: Adaptive Behaviour or Biopower?

Referring to the variability of breastfeeding practices among cultures, he notes:

Evidence from a variety of sources, including isotopic analyses of prehistoric skeletons … is consistent with the long-standing primary role of breast-feeding in infant nutrition, but both the historical and ethnographic literatures offer ample evidence that exclusive maternal breast-feeding for the first six months of life cannot be considered either “traditional” or the “natural” norm.

Furthermore, even when exclusive breast-feeding is practised it is not … an “instinctive” or uniform process.

He points out a phenomenon that contemporary lactivists prefer to elide:

Cultural factors therefore pervade breastfeeding at many levels. As the benefits of breastfeeding become clearer to the medical scientific community, those seeking to influence maternal behaviour, with the aim of improving maternal and child health, must develop an improved understanding of the role of cultural factors in infant feeding…

While all mammals suckle their young, there is wide variation in breastfeeding behaviors:

Mother-infant suckling interactions can be considered through a continuum model … At one extreme are altricial infant marsupials and monotremes, born in a premature condition and spending days or even weeks in the maternal pouch attached continuously to the teat. At the other extreme are the precocial ungulates and cetaceans, well developed and fully able to move on their own from birth. Primates lie between these extremes, and have been termed semi-altricial.

In many species, whether altricial or precocial, suckling is a relatively instinctive process. The newborn kangaroo searches out the teat itself, despite its relatively early stage of physical development… Many ungulates can stand very quickly after birth and orient towards the mother to search for the teat. In contrast, primate infants contribute less proactively to the initiation of feeding … The role of offspring instinct appears to be decreased, and there is an increased role of the mother, including learned maternal behaviour, in instigating lactation…

Even among animals, there is a cultural dimension to infant feeding:

In chimpanzees, our closest primate relative, both tradition and learning contribute significantly to the ontogeny of the offspring’s diet. Whiten and colleagues analysed data from a number of relatively discretely distributed populations, and found that groups inhabiting similar ecological environments nevertheless differed in the types of behaviour demonstrated. This scenario extends to diet, with only a selection of all possible foods eaten by any given group. These analyses demonstrated that both innovation of behaviour within populations, and diffusion of behaviour between populations, were important factors in accounting for nutritional intake.

Chimpanzee nutrition in general, including lactation, therefore involves “culture” – the learning of behaviour from others who have also learned it … This role of culture is relevant to our theoretical understanding of instinct in animal behaviour, and the notion of what is “natural” in human behaviour.

Indeed:

Despite the tendency to portray human breastfeeding as a “natural” process, in opposition to supposedly “unnatural” approaches such as bottle feeding, the reality is that there is no single “instinctive “ or “natural” way to breastfeed…

Breastfeeding resembles sex in this way. Labeling exclusive, extended breastfeeding as natural in opposition to any possible variation makes as much sense as labeling the missionary position natural and any other forms or practices of sexuality as “unnatural.”

Both lactivist recommendations and medical recommendations about breastfeeding often ignore this fundamental reality, assuming — despite widespread evidence of a multiplicity of cultural practices around breastfeeding — that exclusive, extended breastfeeding is “natural.” Then, through the use of biopower, they pressure women to conform to a “natural” practice that never existed in nature.

Biopower does not involve overt repression or force, but employs quiet and subtle coercions whose very invisibility enhances their effectiveness. Techniques include normalizing judgements which subtly define the properness of an indivdual’s behaviour, the institutionalisation of knowledge through which individuals are objectified and devalued, and the “panoptic gaze” which subjects individuals to continual surveillance …

That is similar to the way in which biopower is exerted around homosexuality and gender identity. Until very recently, our society objectified and devalued gay and transgender individuals, in some cases going as far as characterizing their behavior as criminal.

The exertion of biopower around breastfeeding has been going on for centuries:

While the literature does not tell us what women actually did in previous generations, it shows that male institutions and interest groups have had a long-standing role in prescribing “optimal” feeding, while also simultaneously containing many normative judgements of acceptable and unacceptable maternal behaviour…

The central role of breastfeeding in the generation of biopower can be attributed to the competing demands on women’s identities and hence behaviour. Women may simultaneously be daughters, sisters, wives or partners, and mothers. Perhaps most importantly, the sexual relationship between women and their partners may conflict with maternal roles, particularly given the relationships between lactational ammenorrhoea and breastfeeding duration. Maher has argued that male control over breastfeeding tends to be stronger in societies emphasising marriage and childbearing as “institutions for the confirmation of wealth and status”. More generally, the nature and duration of breastfeeding are a function of negotiation between the two sexes pursuing different goals …

Of course men are not the only ones who employ biopower around breastfeeding. Lactation professionals consider it an imperative to pressure women into breastfeeding whether they want to do or not, whether they are capable of doing so or not, whether it is in their best interests and the best interests of their babies or not.

They are no different than insitutions and authority figures who consider it imperative to pressure all individuals into heterosexual, penetrative, intravaginal intercourse whether that is what they want to do or not, whether it is in their best interests or not.

The bottom line is that the decision by lactivists to portray exclusive, extended breastfeeding as natural is an example of biopower in action.

It isn’t merely longing for a past that never existed; it can be actively harmful to women and babies.

  • strewth

    I have a good friend who breastfed her daughter until the age of about 3 (because they both enjoyed it and she totally wasn’t preachy). I definitely enjoyed when the kid was having a screaming emotional meltdown and it was abruptly stopped by the simple expedient of sticking a nipple into the open maw.
    Personally, if it wasn’t for formula, I wouldn’t have lasted more than a couple of days. Insufficient breastmilk is a bitch. And I think having a mom who was a highly educated and skilled specialist physician did a lot more for me as a girl growing up than any magic boob juice could have done. Not to mention a live-in grandmother who taught me to love reading at an early age (she also formula fed her 6 kids, 4 of whom became doctors…)

  • guest

    My baby certainly didn’t think extended breastfeeding was natural. She weaned herself off the breast at eight months old. She was just done with it. She would take bottles of formula and solids, but had no interest at all in breast milk at that point. And why should she? She was mobile enough that she could go exploring and do more interesting things than hang on to mom’s breast and stare at the same thing for fifteen minutes.

  • sheistolerable

    Dr. Tuteur, I really appreciate how you bring insights from other disciplines into the information you present. It is nice to see an MD appreciate the insights of the social sciences and humanities.

    You may have written about this before, but when you make the point that 15% of women may have insufficient breastmilk, I always think about the historical insight I remember learning that one of the most common reasons women were killed during the European witch panics was for allegedly causing other women’s milk to dry up. That too would suggest lactivists are wrong about the universal effectiveness of breastfeeding for all women until this evil modern period.

  • Amazed

    Oh my, this Olivia Windridge is a thing! No zealot can compare to the one who can’t practice what they teach.

    This woman is pitiful. She can’t breastfeed but she so wants this cool mommy badge, so she tries to run behind the big dogs and bark like them while she’s just a malicious but tiny puppy whining, “Please let me be cool as well! Please acknowledge me!”

    I would have been sympathetic if she wasn’t this nasty on her high horse.

  • Amy Tuteur, MD

    My latest piece for Slate: Formula is Feminist! The British Medical Journal’s recent decision to ban formula ads doesn’t add up.

    https://slate.com/technology/2019/03/bmj-decision-ban-formula-bad-for-women-not-based-on-evidence.html?fbclid=IwAR3U04fYiSy2NgNw69SB_iKcDHte3KTBA0m2e79qgq2bcmrWDrjjSMYTBJM

  • rational thinker

    I have heard the argument so many times about how all other mammals practice extended breastfeeding and we are the only species that does not. If you have ever observed some mammals raising their young then you know that is bullshit. When I was little my sister and I both had female cats and had 2 litters each and they were outdoor only pets (this was my mothers rule and I hated it I have no outside pets now only indoor cats). Anyway cats certanly dont do extended breastfeeding I watched when their kittens were being born and watched her raise them in the months after. Guess what at around maybe 2-3 moths I saw mama cat actively trying to ween them. If she was laying down and one came over and latched on to drink she would quickly stand up and walk away. Then she would walk over to the food bowl to show them to eat that and she was hunting things for them too. I dont know for sure but im guessing its the same for dogs or most mammals.

    • AirPlant

      This is probably not the point but cat moms are just mom goals. Such a perfect mix of nurturing indifference with a side of “If you stress me out I will literally eat my young and problem solved”

      • Daleth

        Sometimes I soothe myself, after having expressed annoyance at my kids and wondering if they’re going to need therapy as a result, by remembering that mother cats express annoyance with their kittens too. It’s natural! Sometimes parenting is annoying 🙂

        • AirPlant

          I volunteer in cat rescue and every year we get a few indifferent mothers. Last year one mother in particular took first prize in cat parenting when she one by one removed all of her nine (!) kittens from the gated in foster room, plonked them on the couch in front of the TV and went back into her now empty room for a nap. I wanted to adopt that cat so very badly.

    • strewth

      My kittens are 8 months old and I just found my first dead rodent on the doorstep. I’m so proud 😛
      Cats definitely set the example of teaching your kids how to get by and take care of themselves. The antithesis of “helicopter parenting”

  • Mel

    Heck, the length of breastfeeding is often highly variable among members of the same species depending on the metabolic reserves of the mother, the place of the mother in the dominance hierarchy, the health of the infant and gender of the infant.

    Sub-dominant females are often better off weaning the offspring who leave a little longer since the gender that stays nearby inherits the mother’s low status – and vice versa for dominant females. Likewise, mild stressors often lengthen the length of breastfeeding if it gives the offspring a better chance without harming the mother. Severe stressors often shorten breastfeeding.

    Pretending there’s one magic number is just silly.

  • Mel

    It’s unfortunate that the old joke of “Who breast-feeds for 4 years? A few members of the !Kung people and female anthropologists who read about those few !Kung women” now has relevance outside of esoteric academic circles.

  • fiftyfifty1

    “Then through the use of biopower they pressure women to conform to a “natural” practice that never existed in nature.”

    Yes, and they often do this through shaming language about “natural” and “unnatural” mothers. I remember when I was struggling to breastfeed my first, the first 2 lactation consultants were overtly judging whether my mothering was “natural” or not. They said that the “natural” way for a mother to hold a child was very close belly to belly, with the baby’s head in line with her breast, and nose in line with her nipple. They claimed that this was natural, but that some woman had lost this instinct due to watching too many babies be bottle fed, and then they would hold the baby “unnaturally” more on its back, with the head too far off to her side, and try to place the nipple in the baby’s mouth like it was a bottle nipple. Also that a mother’s shoulders should be relaxed and not “stiff” which indicated that she was conflicted about breastfeeding. For me, you can bet my shoulders were stiff because I was in so much pain. You can bet that I wanted some distance between my baby’s body and my body, because when I got kneed in the other breast while feeding it was just more pain. Anyway, I tried everything they said, but nothing ever worked to make my baby’s suck and swallow normal or make the pain end. I guessed I failed at being natural and having normal mother instincts.

    But then I had baby #2 and it didn’t matter how I held my baby, everything went just fine. Baby’s #2’s suck and swallow were completely normal from any position and alignment whatsoever, “natural” or not.

  • MaineJen

    Small typo in this paragraph: “Why does it matter? Because (are) both natural childbirth advocates…”

  • AirPlant

    I am a pregnant woman so I hear about breastfeeding probably more than the average bear but honestly I really cannot believe how completely and overwhelmingly bored I am of the topic. I have literally no idea how people manage to stay this engaged for so many years to the point where they feel the need to police literally every woman who has ever existed in the history of the planet on their feeding choices.

    • fiftyfifty1

      They keep what would otherwise be a very dry and boring subject interesting by overlaying it with a thrilling Madonna/Whore narrative.

      • AirPlant

        It has to be like any other niche interest right? Like I used to be super into Harry Potter fandom but after about three years I noticed that although there are seven long books of canon and a colorful cast of characters the only way to keep it at all interesting was to start making stuff up about small irrelevant details and spinning narratives essentially from scratch.

        I feel like lactivism starts as an enthusiasm and interest in an activity that a mother spends hours and hours doing for a solid chunk of a child’s first year and spins it into the land of fantasy where you have to spin nonsensical stories about made up benefits in order for it to stay even a little bit interesting. There are just only so many times you can say “up until recently breastfeeding was the only safe way to feed a baby and even now has a spattering of vauge benefits (mostly meaningless in an industrialized country) which formula cannot replicate and also a lot of women like doing it so thats cool” before you want to move on. You need to make it about how Tonks must have interacted with professor McGonagall in her third year class through her inborn animorphmagus abilities and how that is inferred in OotP when you see them briefly interact at the london headquarters.

        • KQ Not Signed In

          OMG now I’m trying to come up with lactivism fanfic pairings. I think I shall ship Ina May with Mercola.

          • AnnaPDE

            Triangle with Leather!JackNewman to mix things up!

          • AirPlant

            No cross pairings? Why not pair Ina May with Umbridge and see if we can get a sugary dystopian power couple.

          • MaineJen

            Cannot unsee…cannot unsee

          • AirPlant

            You know Ina May would get off on that evil detention quill.

          • Sarah

            Her Harry Potter name would probably be Voldeboob.

          • AirPlant

            My vote is Volgina Twiddle personally.

    • Cristina

      Haha, my youngest is 5 and I come here often just to read the off-topic comments

    • Caravelle

      I have a two-month old, and “how are you feeding him?” is the second-most common question I get (and second asked) after “is he sleeping through the night?”. (I even got “are you feeding him?”, which I don’t think sounded better in the original French. I felt bad that I immediately understood what the lady was asking and so didn’t immediately go “duh, he’s still alive isn’t he”)

      I’ve been thinking about this recently because I really think those are bad questions; I don’t know if I should blame society for them, or the fact that newborns aren’t supposed to do much more than sleep and eat so those are questions that make some sense. And I guess in theory it’s two subjects any new parent could go on about at length given the complexity involved; that might be one reason they annoy me, they’re *too* complex. Should I go over the baby’s entire feeding history with you? Should I be tracking his sleep patterns better so I can relate them to strangers? I’ve been trying to come up with what I think should be “the first question you ask a parent with a baby”; I like “what’s the cutest thing it’s done lately?”.

      I guess what I’m trying to say is, if you think you’re bored of the topic *now*…

      • AirPlant

        I get that babies are boring I really do and I get that people are not smart enough to think up interesting questions but OMG I have had the same conversation so many times now it is almost on autopilot.

        “So you will be breastfeeding right?”
        “Nah, not my thing, this is a formula baby”
        “Oh, well you should really at least try”
        “No, I don’t think that is a good idea”
        “Well you might like it”
        “I don’t think I will”
        “Well (I/my wife/all my friends) loved it”
        “I am happy for you/them.”

        Sometimes it goes longer and the expectation always seems to be that I justify myself somehow but the fact is that I just do not want to breastfeed and nothing I have read has ever convinced me that the benefits will ultimately be worth going against my natural revulsion. I honestly don’t even feel guilty, I just feel so very very bored like yep, I am a soulless unloving refrigerator mother who has no hope of emotionally balanced children, whatever, can we maybe talk about baby wearing or like SIDS prevention now because those are things I could use some pointers on.

        • seenthelight

          In my thirties now and questions like that get no traction with me. And if they persist in questioning, they get ‘is this your business?’ But I’ve never been a particularly nice person, so there is that. I am kind and caring, but not nice, I don’t want to discuss private medical decisions with anyone but medical staff and my husband, and frankly it’s rude of others to presume that I want to share that kind of info with them. ‘oh, there’s a baby in your belly, that means what you plan to do with your breasts is now public conversation!’ NO. It’s not. I plan on feeding this baby, but the method is not up for discussion.

          • Cristina

            I was 5 months pregnant with my first and at a hardware store buying paint. The woman commented on the pretty color and I said it was for the nursery and she immediately asked if I was going to breastfeed and if so, blah blah blah.

        • Daleth

          My best French friend was the only friend I had who didn’t ASSUME I was breastfeeding. She actually asked, “Are you going to breastfeed?” (Totally casually, not like she cared which way I answered.)

          All my American friends just assumed that I was. There was even some “rah rah sister, leaky boobs happy babies wow it’s tiring but so amazing” cheerleading from friends who’d become mothers before me. It didn’t even occur to them that not EBF’ing might be a thing.

    • Cat

      This! I’m at a different stage in the process because I have a three year-old, but seriously, if I never hear one person talk about infant feeding methods again, it’ll be too soon. And three years down the line, it’s glaringly obvious that the people who totally obsessed over those choices (rather than just doing whatever worked best for them) really wasted their energy, because three year-olds are all much of a muchness. The ones who were extended EBF aren’t any smarter or more bonded or less prone to childhood illnesses than the rest. They’re just little kids. If their mums enjoyed breastfeeding and found it the most convenient choice, that’s fantastic, but if they did it because they were promised a superior sparkly unicorn child, then they should really ask for their money back.

      • Inmara

        Some of my acquaintances have three year old kids and still are breastfeeding, just trying to wean them now and having a hard time at that. I’m biting my tongue not to comment anything – it was their choice, it was their kids, not mine, and apparently it worked well for them so far (more for soothing, not the nutrition or any overblown health benefits). But I shudder every time imagining that I would have to breastfeed my kid for so long. To be honest, he still uses baby bottle to drink his morning and afternoon milk but mainly because it’s spill-proof and he likes to drink it in his bed right after waking up, otherwise we would have arranged his mornings with a cup of milk at table.

        • Cat

          In principle, I’m totally cool with breastfeeding going on for as long as it works for the mother and child. It’s none of my damn business, after all. If I’m honest though, I get a bit stressed and anxious reading those smug blogposts about extended breastfeeding where the mum is all “we’ve never had a single tantrum and we’ve sailed through all the childhood illnesses because boob is a magic solution for everything” . I’ve no problem with breastfeeding as one source of comfort amongst others, but encouraging your kid to rely on the breast as sole source of comfort and emotional crutch when it won’t be around forever? Seems short-sighted at best, cruel at worst.

          (It’s not just a breastfeeding thing though – I used to be equally troubled by a couple of mums at my kid’s playgroup who’d use a pacifier as a first resort, every time their kids so much as squeaked. And these weren’t babies, they were little girls who were starting school in six months time).

  • Cartman36

    regarding Biopower the “techniques include normalizing judgement”. Yes! such as a hospital instituting BFHI policies and forcing women to do things (room in, visit with a lactation consultant) despite their preferences. this leads to the normalization of judgement against women who do not EBF.

  • Cartman36

    I think you meant distinct notdiscrete in the second paragraph 🙂

    • Cartman36

      LOL! Nevermind. I just looked up the definition of discrete which differs from discreet.