Battle in Print: Expression management: Infant feeding and maternal anxiety

Charlotte Faircloth, 15 November 2007

The milk is all that matters ... It is so very difficult to pump enough milk for a baby who must spend much of her day away from you that a mother can get a little obsessed at times. Pumping milk starts to take up a lot more space in your mind than you ever thought it would. Getting milk for that baby becomes your primary purpose, almost. It’s exhausting.
- Mariah, a ‘Pumping Queen’ (quoted in Hicks 2006)

He’s had 4 ounces so far this morning, but the midwife said that we should be aiming for at least 6-8 [ounces] each time because of his weight, so I’ve mixed some SMA white [formula] in with it too ... He’s only put on 85g this week so she told me off for that ‘cause that means he’s still on a low percentile or something, though she also said he looks healthy enough ... I feel bad about giving him the formula, but, you know, if I can’t make enough for him myself, what am I supposed to do?
- Roopa, feeding her 4 month old son

I had a freezer full [of expressed breastmilk] which I never even used. I don’t even know why I brought a pump to be honest - I think I just thought I should ... Something else I should do. I couldn’t bear the thought of his little body being swamped by formula, and I was terrified he wouldn’t have anything to eat if something happened to me.
- Amy, feeding her 12 month old son

Breastfeeding itself was difficult because of her weak latch, so now I’m expressing, and I know exactly how much she is getting, which is so much easier. Plus, I still have that special bond with her ... you feel like a milking machine sometimes, but, I do it because I love her, and I want her to have the best.
- Dawn, feeding her 6 month old daughter

One of the most startling features of the culture surrounding modern parenting is the tidal wave of advice parents can expect to receive about what is best for their children. Where in the past ‘muddling through’ was perfectly acceptable, today the job of raising children is understood to be too important to leave to parents. Instead, the government, and a bevy of interested parties, are on hand to enable and ‘support’ Good Parenting.

‘Information’ about how, and with what, to feed children is a perfect example: from the word go parents are surrounded by dos and don’ts about what to put into their children’s stomachs. This is understood to be important for optimising the health of children, and indeed, the future adult population as a whole. How women feed their babies has therefore become a major issue for a range of agencies - whether government, NGO, volunteer support group or, increasingly, an amalgamation of the three.

On the question of infant feeding, the agencies speak with one voice: Breastfeeding (exclusively for six months) is Best, and formula feeding is Bad. Indeed, many put formula feeding, which might seem the obvious alternative, into fourth place - after exclusive breastfeeding, feeding the baby with your own expressed breastmilk or feeding with another woman’s expressed milk. One of the effects of this demonisation of formula is that infant feeding has intersected with maternal identity in an unprecedented way (Lee forthcoming). Under the current orthodoxy, providing one’s child with breastmilk has become a litmus test of maternal devotion (Woodburn 2006). How a baby is fed has become a marker of a mother’s identity, and a way in which women understand themselves, and those around them, as mothers.

The expression of breastmilk (by hand or with a pump, for feeding from a cup or bottle) has been central to the infant feeding issue in the US for some time, where six weeks maternity leave is standard (Blum 1999). It is sold as offering the ultimate solution for modern women, in part through the merging of the domestic and public spheres. Separating the product from means of production means that the child benefits by receiving breastmilk even when it is unable to extract it itself, or when the mother is absent. The mother is therefore able to invest her energies in other labours (such as employment). A woman doesn’t have to expose her breast in public; a third party can engage in the feeding process (meaning ‘bonding’ can be shared); and parents can see exactly how much the child is eating (very important when every gram of weight gain or loss is rigorously scrutinised).

Despite longer maternity leave in the UK (generally six months), a growing part of breastfeeding promotion has been concerned with educating women about the benefits of expressing milk. I use the comments presented above - from my research into motherhood and infant feeding - to explore broader tensions in modern parenting by teasing out some issues concerned with offering women this ‘ultimate solution’. The mothers I work with endorse a specific philosophy of parenting which puts breastfeeding at the centre of the mothering experience. Their ideas are therefore not representative, though I hope readers will note the salience of their remarks as reflective of a shift of the culture surrounding parenting.

Monitoring parents: Measurement and expertise

Women’s perceptions about feeding their children are moulded by an era in which the monitoring of parents, by a range of agencies, is taken for granted. Such monitoring is welcomed, since it is understood to provide parents with reassurance that they are doing The Right Thing in a time where a plurality of parenting options exist. Intensified monitoring, or ‘support’, in recent years means that parents are more accountable than ever, in correlation with the increasing amounts of ‘information’ they are privy to .

The current orthodoxy new mothers encounter in feeding advice is that ‘breast is best’ - ideally exclusively and on demand during the first six months of a child’s life (DoH 2005). The idea is romantic: a child should be fed little and often from the breast, rather than at regulated times or in regulated quantities. This is said to be most appropriate for an infant’s developmental needs, both bodily and emotional. Yet, ironically, the idea is spoken in the language of rationality, expressed in a preoccupation with measurement. How much, how long and with what a child is fed are questions new mothers will be expected to account for, despite the lip-service to a more ‘free and easy’ approach.

The culture of measurement is evident in how women talk about feeding their babies. Roopa talks in ounces of milk and grams of weight, and Dawn says she prefers to express milk (to breastfeeding) because you ‘know how much’ the baby is getting (my emphasis). Measurement makes things visible, which in turn renders them knowable and accountable (see Strathern 1997). To know that a baby has had ‘only 4 ounces’ of milk makes a mother aware of her deficiency if the guidance is that the baby ‘should have 6-8’. The effect of this move is that a satisfied baby who ‘looks healthy enough’ does not present reassurance for the mother. Instead, the gradations on the side of a bottle and the markings on a weight chart must be used to show the baby’s ‘truth’. Critics have spoken about mothers’ visits to health clinics to weigh their babies as ‘rituals of reassurance’ (Sachs 2007) - the objective, external gaze of the scales providing the internal, subjective confirmation women need that they are doing The Right Thing.

A culture of measurement (of every ounce of milk, gram of weight or length of feed) has precipitated two interesting effects here: (1) it implies that parents cannot be trusted to do their job themselves (with or without the help of the scale) and (2) it encourages parents to adopt the role of listener to ‘experts’ in place of trusting their own judgements (Furedi 2001).

Even when designed to create reassurance (via transparency), the monitoring of mothers through the bodies of their infants creates space for blame. Mothers can succeed or fail: Roopa talks about being ‘told off’ by the midwife for her baby’s slow weight gain. The almost inevitable misalignment between the expected ‘norms’ of the charts and the individual child under observation (only one per cent of children could actually ever represent the ‘normal curve’ of the middle percentile) fuels the need for experts who can aid parents in achieving normality. No longer can parents trust their own feelings about their child’s development - they must seek expert guidance to have it confirmed.

Under the United Nations Baby Friendly Initiative (BFI), a global ‘Gold-standard’ accreditation system for maternity facilities, all new mothers are taught how to hand-express their milk (Unicef 2007). This has many benefits, since it can help mothers (whether they wish to breastfeed or not) who experience pain associated with milk production in alleviating their symptoms. But it is not only taught as a medicinal technique - it is also assumed that mothers will want to express milk, both so that they will be able to engage in other activities (like work away from the child) and to allow others to participate in feeding. It seems some women do not question this orthodoxy, even if they never actually use the milk they produce: Amy has a ‘freezer full’ of expressed milk largely because she feels it is a skill she should master. She did this despite wanting to feed her child from the breast exclusively, and having no plans to go back to work. Logic dictates that the chance of ‘succeeding’ at a skill (expressing) requires the possibility of ‘failure’ - in the language of contemporary motherhood this is very grave indeed.

Where the possibility of expression and storage of milk exists it can easily become an injunction: many women have recounted being frowned upon for starting to use formula milk on returning to work. Implying some kind of failure, they are asked ‘couldn’t you express?’ For women who find breastfeeding difficult, a plethora of lactation aids which simulate breastfeeding via networks of bottles and tubes, makes ‘admitting defeat’, by using formula milk, increasingly hard to account for. And the coin has two sides, of course: Those that continue to breastfeed when back at work (by bringing the baby with them or arranging special visits) are frowned on too - ‘Couldn’t you express instead?’ they are asked by disgruntled colleagues.

The ‘breast is best’ literature, which talks not of benefits of breastfeeding but of risks of formula feeding, is so striking for some women that any alternative is demonised. Amy therefore ‘couldn’t bear’ to have her child’s body ‘swamped’ with formula, which in several women’s accounts was talked of as ‘junk’, ‘rubbish’, or in one case ‘poison’. The energies required to pump enough milk for six months’ feeding are minimal in the face of such ‘risk’. (In the words of one book, one should ‘Scale Mountains’ to become a ‘Pumping Queen’).

So despite receiving breastmilk exclusively for the first six months of life, there are a growing number of babies who are never actually fed at the breast (Ryan 2007). Critics of the ‘pump culture’ claim that children (and mothers) greatly miss out by not actually being in skin-to-skin contact for feeding, since jaw and eye development is hindered, the supply-demand relationship of milk production put out of kilter, and the production of antibodies specific to the maternal-infant environment disrupted. Yet as a bodily fluid, breastmilk also takes on meanings far beyond this framework of health. To many breastfeeding advocates, any sort of separation, in the form of a bottle or teat, is seen as damaging for the child. There is concern that something essential to the mothering relationship is missing when mediated by a bottle or pump.

Dawn herself says she feels like a ‘milking machine’ at times. Note, however, that the fact that her daughter receives her breastmilk allows Dawn to continue with the ‘special bond’ even though she is not with her, unlike formula (or any other) milk would. There is something indispensable about her milk from her body - and hence Amy was also ‘terrified’ about ‘something happening’ to her. Dawn looks at photos of her baby when she is expressing milk to encourage the psychosomatic ‘let-down’ reflex. Mingling the discourses of health and maternal emotion, the milk itself becomes a symbol for the relationship - ‘an expression of love’, we might say (see Lupton 1996).

Intensive motherhood, breastmilk and maternal identity

Part and parcel of the latter-day culture surrounding parenting is that - however you do it - it must be done intensively, rendering appropriate those methods of parenting which are ‘child-centred, expert-guided, emotionally absorbing, labour intensive and financially expensive’ (Hays 1996: 8). Sharon Hays has written that parents, more than ever, are encouraged to ‘spend a tremendous amount of time, energy and money in raising their children’ (x), in a process which is increasingly understood as part of their own ‘identity work’ and feelings of personal fulfilment. As Lee and Bristow (forthcoming) comment, where mothering is understood as both the problem and the solution to a range of social problems - ‘the last best defence against what many people see as the impoverishment of social ties, communal obligations, and unremunerated commitments’ (Hays 1996: xiii) - this issue is particularly acute.

As a parent, the choices one makes (whether to breastfeed or formula feed, for example) serve as markers within a highly accountable arena. Where ‘breast is best’, individuals must engage in identity work to account for their deviance or congruence to the advice (see Lee forthcoming; Murphy 1999). Echoing work with mothers who use formula milk in the early months, note how Roopa feels ‘bad’ for giving her baby SMA milk. The substance itself comes to stand for her devotion to her baby, leaving her a ‘bad’ mother.

Expressing milk is, of course, not breastfeeding, which an ideology of intensive motherhood defines as the most appropriate choice for women. Yet the effort and discomfort that women go to in providing breastmilk for their children is lauded in a culture of intensive motherhood. It is labour intensive and, in some cases, financially expensive. It is notable that a startlingly profitable industry has sprung up around ‘enabling women to breastfeed’, not least in the form of breast pumps, which mothers are encouraged to think of as an essential requirement of breastfeeding (along with nipple shields, special pillows, slings, lactation aids, creams, clothes…) Expressing is certainly rationalistic and expert-guided, since it celebrates the correlation between several sorts of measurement. It is also child-centred, and, for many women, emotionally absorbing - many of the stories I heard had a distinctly martyr-esque tone. Women would talk proudly of tremendous effort to combine work and breastfeeding, but always in the language of love for their children (Hicks 2006).

Yet there is a final irony here. Where maternal identity is bound up with how a baby is fed, mothers are increasingly pitted against each other, looking to experts in place of offering each other the reassurance and support they need. As Lee and Bristow (forthcoming) write: ‘while intensive mothering seeks to “fill the holes” in a disintegrating social fabric, this culture may have the opposite outcome, encouraging instead strains and tensions in the informal networks on which vibrant, dynamic communities are built’.

Expression management?

Contemporary forms of expression and storage of milk have undoubtedly opened new and rewarding possibilities for modern women as they combine feeding their children with other aspects of their lives. It has not been my intention to disrespect that here. It has rather been to point out some of the implications of these possibilities, particularly where the boundary between option and injunction becomes ill-defined.

The logic of measurement, accountability and expertise has left many women feeling unable to trust the evidence of their own bodies and babies, instead requiring reassurance from external agencies - not only with feeding and weight gain, but with a plethora of parenting ‘skills’. Insistence that formula milk is Bad and that mothers now have no excuse not to provide recommended amounts of breastmilk, contributes to the demonisation of parenting. This does no one any favours, and, indeed, could leave parents feeling more obsessed, isolated and anxious about what they do best - parent.

Author

Charlotte Faircloth is an ESRC funded PhD student in the Department of Social Anthropology at the University of Cambridge. She has worked as an author and consultant for UNICEF, the NCT and Save the Children. She is also a member of the IOI Parents’ Forum. Email: .(JavaScript must be enabled to view this email address)

References

Blum, L. (1999). At The Breast, Ideologies of Breastfeeding and Motherhood in the Contemporary United States. Boston, Beacon Press.

DoH (2005). Maternal and infant nutrition. Department of Health.

Furedi, F. (2001). Paranoid Parenting. London, Penguin.

Hays, S. (1996). The Cultural Contradictions of Motherhood. New Haven and London, Yale University Press.

Hicks, J. (2006). Hirkani’s Daughters: Women who scale modern mountains to combine breastfeeding and working. Schaumberg, Illinois, La Leche League International press.

Lee, E. (forthcoming). ‘Health, motherhood and morality: women’s experiences of infant feeding with formula milk in the early weeks’. Sociology of Health and Illness.

Lee, E. and J. Bristow (forthcoming). ‘Rules for feeding babies’ in Individual Freedom, Autonomy and the State: the limits of intervention in private life. Oxford, Hart.

Lupton, D. (1996). Food, the Body and the Self. London, Sage.

Murphy, E. (1999). ‘“Breast is best”: Infant feeding decisions and maternal deviance’. Sociology of Health and Illness 21(2): 187-208.

Ryan, K. (2007). ‘Insights from the Dipex study’. Conference paper presented at ‘Maternal and Infant Nutrition and Nurture’, University of Central Lancashire.

Sachs, M. (2007). ‘Weight monitoring of breastfed babies in the UK’. Conference Paper presented at ‘Maternal and Infant Nutrition and Nurture’, University of Central Lancashire.

Strathern, M. (1997). ‘From improvement to enhancement: an anthropological comment on the audit culture’. Cambridge Anthropology 19: 1-21.

Unicef (2007). 10 Steps to successful breastfeeding. Unicef. (Accessed 1.8.2007)

Woodburn, J. (2006). ‘The breast of times’. Salon Magazine. 18 September. (Accessed 28.9.2006).

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