Breastmilk, the Movie: a Review

With both my husband and I working on our family farm, and having six homeschooled children, there is nearly always somebody around the homestead.  However, finding myself with only a sleeping baby in the house over the weekend, I took the opportunity to watch the documentary, Breastmilk, the latest from executive producers Ricki Lake and Abby Epstein (who previously directed and produced The Business of Being Born; and More Business of Being Born).  While there were certainly troublesome segments (such as the “feminist” who graphically exalted “lactation porn”...and the random images of spouting breasts) which require that I post a Do Not Watch In Mixed Company or In the Presence of Children warning, the overall message—that successfully breastfeeding a baby in the United States is practically a miracle—came through loud and clear.  By following a handful of mothers from late in pregnancy through their baby’s first year of life, Breastmilk reveals how terribly difficult it is for American mothers to make milk.

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In watching the documentary, I found myself relating to the one mother in the documentary who successfully nursed her baby as she described the odd experience of lending a sympathetic ear to all of her friends who could not breastfeed, but feeling there was no place to share her own prosaic story of breastfeeding success.  Breastmilk left me with feelings akin to survivor’s guilt.  While my own social circles contain a far higher percentage of successful breastfeeding mothers than were included in the documentary, I have experienced a less extreme version of the same story, as it seems that breastfeeding problems are the rule, not the exception.

Though a dual certified birth doula, my decision to practice a “radical” form of breastfeeding, which eschews all bottles and pacifiers (even if filled with breastmilk), means in practice that being present at births is nearly impossible...a fairly serious impediment to practicing my trade.  However, despite hearing of its frequency in other breastfeeding moms, in fourteen years of nearly continuous breastfeeding, I have only once come close to mastitis—and that was during one of the handful of times I have assisted as a birth doula and was separated from my baby for longer than usual.  Staying with one’s baby the bulk of the time certainly makes breastfeeding simpler.

My son in the NICU

When my sixth child needed intensive care and tube feeding following his birth, I found myself in the awkward position of needing to learn how to pump my milk for the very first time.  Only the lactation consultant on staff seemed to find it normal that I had never pumped or fed from a bottle.  In America, we don’t breastfeed; we pump-and-bottle-feed.  We directly “feed” plastic bottles and lines of tube—and babies only indirectly.  I find it increasingly common to hear of mothers who exclusively pump-and-bottle-feed, even when they are with their babies most or all the time.  Many babies, as the little humans they are, seem to prefer the ease of the faster flow of milk from a bottle--milk that spills right out--rather than the milk they have to work to nurse from their mothers.  While there is nothing wrong with the choice to pump-and-bottle-feed (and this choice has many benefits compared to formula feeding), pump-and-bottle-feeding has the disadvantages of the lack of full hormonal release and most effective suckling and emptying of the breast that a baby gives.  Over time, it may well have a negative effect on the mother's milk supply.

Similarly, many mothers find nursing in public (a necessity unless you never leave your house) incredibly uncomfortable and embarrassing.  Carrying a bottle of pumped milk magically eliminates this embarrassment.  No one looks twice when a mother feeds her baby with a bottle.  However, as I can attest from an outing just yesterday, feeding a baby from the breast—even with a nursing cover—merits triple takes!  It is simply ridiculous that an act that defines our species, that our very species has relied upon for survival, is seen as something immodest, scandalous, and by some, even disgusting.

...Should have worn my 
I AM A MAMMAL: 
ARE YOU?
hat...

How have I been able to feed six children without a bottle in the house?  And more directly: Am I a hippie who also smokes joints and flips peace signs at the least provocation?  Sorry; no joints and no peace signs—not even during the “passing of the peace” at church—but I probably still qualify as a hippie.  I home birth; home school; and have a home business—teaching natural birth classes among other things.  On more than one occasion, I have actually been barefoot and pregnant.  But my “style” of breastfeeding wasn’t the result of following the example of my peace-loving foremothers; it was the result of following the example of one woman: Sheila Kippley.

While the two Business of Being Born documentaries provided alternatives to medicalized childbirth—namely, natural childbirth; out of hospital births; midwives; and doulas--Breastmilk has no practical help to suggest.  A new mother could easily conclude after watching the film that if she doesn’t have a close female friend or partner willing to share in the nursing in order to keep her baby alive, she is destined for breastfeeding failure.

The Community Health Worker featured in Breastmilk wondered aloud what it would be like if WIC didn’t give mothers formula—in her words, if they “forced” mothers to breastfeed exclusively.  Yet the stories of the mothers featured in the documentary demonstrate that withholding formula doesn’t go far enough.  If we want to make breastfeeding easier for normal, healthy moms and babies, we also have to withhold the pump, and keep moms and babies together.  Doesn’t seem realistic?  For those moms who are unable or do not wish to be stay at home mothers, work places with on-site childcare need to receive public praise and public support.  And we need to be unequivocal about our babies.  I find it hard to believe that the librarian complaining about the lack of onsite childcare in Breastmilk was the only mother in the school district who wanted such care.  For all the moms at work places that do not yet offer onsite childcare, determination is needed to reach out to the other pregnant or nursing mothers at your company.  Get together and brainstorm ways to help your babies stay with you at work; don’t sit around and wait for someone in management or leadership to come up with a solution.  Encouraging nursing moms at the work place requires an entire work place culture of breastfeeding support, but it will likely start with determined mother-workers who themselves come up with creative, business-positive solutions.

Revealingly, the title of this image is "WIC-baby-happy" Source: parentsofcolorseeknewborntoadopt.wordpress.com

In natural childbirth classes, the “Cascade of Interventions” is a common topic of discussion.  I have not noticed the same concept discussed often enough in reference to breastfeeding, although interventions in the childbearing process, both before, during and immediately after birth and throughout the early postpartum weeks definitely affect the ability of the mother to initiate breastfeeding and keep breastfeeding.  (View a chart here that I share in my natural birth classes.)  Furthermore, there are interventions in the breastfeeding process itself that directly impact breastfeeding success.  Just as the natural childbirth movement has been successful in explaining those interventions in the normal birthing process that can result in poor outcomes for the birth, there needs to be a Natural Breastfeeding movement that informs and educates mothers and families about the interventions in breastfeeding that result in poor outcomes for breastfeeding, and more importantly poorer outcomes for babies.

Though the makers of Breastmilk failed to present an alternative to what could be termed “technological” breastfeeding, the reality is that the “natural breastfeeding” model already exists and was described in seven steps over forty years ago: ecological breastfeeding.  When Sheila Kippley described what some of its followers call “eco breastfeeding” she must have been considered very radical indeed.  In 1971, breastfeeding initiation rates (mothers who nursed at least once before being discharged from the hospital) hit an all-time low of 24%. (1)  While breastfeeding initiation rates are much higher today (with 79% of mothers initiating breastfeeding in the United States in 2011) (2), they are still below the Healthy People 2020 goal of 81.9% in all but 17 states. (3)

While great strides have been made over the past 45 years in breastfeeding initiation, improvements in length of breastfeeding lag behind.  About half of America’s babies are already weaned by 6 months of age and less than one third are still nursing at one year of age, (3) despite the recommendation that babies receive at least some breastmilk for at least a full year by the AAP (4) and a full two years "or beyond" by the WHO (5).  If the mothers in Breastmilk are representative, most mothers begin their breastfeeding relationship convinced of the benefits and cautiously optimistic about their own chances for success.  However, interventions in the birthing process and immediate postpartum; easy access to artificial baby milk; well-meaning but ill-informed physicians, government workers, and other authorities; baffled, worried and exhausted husbands, partners and relatives; worries about baby’s growth; a desire by the mother for some sense of control in a process that seems mysterious and lacking in objectivity; as well as misinformation and the undeniable “evidence” from the pump all conspire to undermine the mother’s confidence.  Pretty soon she’s supplementing and without the message from her body to make more milk, her supply drops and with little encouragement or practical help, she may quit all together, convinced she couldn't make 'enough'.

Leonardo da vinci, Madonna Litta c. 1490-1491. Source: wikimedia commons

In the coming weeks, I will explain in detail the seven components ("Standards") of Sheila Kippley’s Ecological Breastfeeding Program, and then conclude with a series of blog posts written for people in positions key to breastfeeding success or failure, providing specific suggestions for things we can do to support breastfeeding mothers and families.  I invite all those of goodwill to join with me in promoting Natural Breastfeeding, for the health and well-being of mothers and babies everywhere.

Note to Lake and Epstein: time to start filming More Breastmilk.

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Three Things You Can Do to Support Natural Breastfeeding Now

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References:
(1) "Low Breastfeeding Rates and Public Health in the United States,"  American Journal of Public Health, 2003 December; 93(12)2000
(2) "Breastfeeding Report Card United States 2014" Retrieved from: http://www.cdc.gov/breastfeeding/pdf/2014breastfeedingreportcard.pdf
(3) "Breastfeeding Benefits & Barriers: Breastfeeding Statistics in the United States" Retrieved from: http://www.breastfeedingbasics.org/cgi-bin/deliver.cgi/content/Introduction/sta_us.html
(4) "AAP Reaffirms Breastfeeding Guidelines" Retrieved from: http://www.aap.org/en-us/about-the-aap/aap-press-room/Pages/AAP-Reaffirms-Breastfeeding-Guidelines.aspx
(5) "The World Health Organization's infant feeding recommendation," Retrieved from: http://www.who.int/nutrition/topics/infantfeeding_recommendation/en/