"Hypnosis in breastfeeding by Andréine Bel & reactions
Posting to OBCNEWS, 20 April 1999Andréine Bel <contact@bioethics.ws>
Immediate breastfeeding, a relatively recent leitmotiv, seems to be a "must" in the "natural" approach of birthing and the hobbyhorse of all midwives and doctors wanting to get as close as possible to "nature".
Nevertheless, a delay of one or two days in breastfeeding seems to be still commonly practised in the world. In a medical environment, this custom is associated with the separation between the newborn and her mother for many reasons claimed by interventionists.
However, when I read or ask about the history of breastfeeding in France, I realise that this delay has since long been customary in homebirth, and that it is one of the few habits that were brought by midwives into the hospitals.
Besides, in my recent research on Indian midwifery, I found the same custom in remote rural areas of India (Maharashtra, Bihar), the ones which have not yet been influenced by allopathy, obstetrics (and Western "experts" in "natural" birth!) and whose women take special care in staying with their babies day and night. These people belong to what Michel Odent might call the "environmentalists". All women I met or interviewed (including ayurvedic doctors) were categorical: the first thing to be given to the baby is generally a small quantity of water with honey, brown cane sugar or goat milk. This for one, two or three days depending on communities and regions. A survey involving twenty five field-based non-government organisations (NGOs) in eleven different states of India provides details about pre-breastfeeding which corroborate my own investigation. (Vd. Smita Bajpai & Mira Sadgopal, "Her Healing Heritage", Ahmedabad: Chetna, 1996, p.136).
Still, the fact that a delay is or was practised in France, so widely in India and possibly in other countries (the ones out of reach of medical care, according to a Mexican friend) is certainly not for me a good enough reason to adopt this custom. I sincerely wish to look with new eyes to each and every event during a delivery!
When my son was born at home, I was as close to him as one can dream of. He was skin to skin between my breasts, there was no interference whatsoever, and I did not have anybody to show me or him what to do. Each cell of my body was awake, he was there, peaceful and attentive. Indeed, he had the sucking reflex from the beginning, which I checked. But he was not hungry. He did not try in any way to suckle colostrum before the placenta was born, nor later, until he rejected his meconium. For two days, waiting for him to be hungry, I gave him teaspoons of water with a few drops of lemon and honey.
Then, he took breast, calmly. He was ready, and my breast as well. Twenty years later, my friend's new-born girl reacted the same way. She also was born at home, with no outside interference.
Now, let us examine the arguments given for immediate breastfeeding.
Taking from my enquiry <http://bioethics.ws/dais/daicomp.htm#feeding>, in brief:
the reflex of sucking is ensured;
colostrum benefits to the new-born;
it helps for the meconium to be evacuated;
no risk of harm from foreign element;
stimulation of the mother's nipples, which in turn facilitates the expulsion of the placenta, the contraction of the uterus (so important for so many reasons), and the flow of colostrum and milk;
it allows or facilitates the bonding between mother and child.
1- The reflex of sucking is ensured.
It is well known that the reflex of sucking is spontaneous for a mature new-born, if no drug has been given to her nor to the mother during the delivery. If this condition has been respected, there is normally no need to ensure this reflex. Moreover, in India again, ayurvedic doctors suggest putting a drop of honey on one's finger and giving it to the baby to suck and indulge the taste of sucking. Poor people who cannot offer honey give plain cane sugar molasses.
2- Colostrum benefits to the newborn.
It is precisely because colostrum is so important for the health of the baby and future adult that it should be assimilated in the most proper way.
To my knowing, colostrum lasts for two or three days, then is replaced by milk, whether the stimulation of the breast happens immediately after birth or one or two days later.
With no early stimulation, it takes about two or three days for the colostrum to flow, the same average time that it takes to the baby for pushing out the meconium.
When the early stimulation is natural, so to say when the newborn eagerly searches for her mother's nipples, there are certainly some good reasons behind it. The baby might have already expelled the meconium, the early intake compensates for some previous imbalance, or it points at specific tempers, baby's and mother's.
In other cases, an early stimulation is an induction.
When immediate breastfeeding is artificial - as a result of the fear put on women that if their baby does no suck immediately, it is a bad sign or it deprives her of the best for her health -- I consider it as a "hypnosis", something "experts" in birthing think they have the right to impose on women. This induction is similar to all interventions which accompany classical obstetrical deliveries. In this case, the mother will take advantage of the sucking reflex and convince her baby to take colostrum, with such a "loving care" (produced by anxiety) that most babies would not resist. Hunger comes by eating, indeed, but a compulsive eating behaviour might as well originate in the over-feeding of infants... Parents and attendants are in paradise: their baby is taking breast, the last step of the delivery has been passed successfully, let us take snapshots showing the "healthy" mother and child! In such a conditioning, it becomes true that if the baby does not respond it usually points at a health problem.
3- It helps for the meconium to be evacuated.
I never heard of any healthy baby not having pushed away her meconium one day or the other, even if she fasts.
Let us consider the case when the colostrum is expelled immediately after birth.
The colostrum has depurative properties. As soon as it reaches the baby's intestines, it evacuates the meconium, and, doing so, the colostrum is evacuated as well.
We are left with an intestine cleaned earlier but unable to benefit fully from the colostrum.
When we leave time for nature to work, the colostrum comes after two or three days, which is the time usually required for the meconium to be spontaneously pushed out. The baby becomes hungry because her intestines are clean and her hunger is met immediately with this highly rich food which reinforces her digestive (and immune) systems ready to receive and benefit from it.
4- No risk of harm from foreign element.
It is true that the mother's milk is the best for the baby, and that a feeding with foreign food is either inferior in quality (processed milk), or dangerous (indigestible).
Still, doctors are fearing a priori haemorrhage for the new-born who cannot process vitamin K until a foreign element comes to her intestines. So they currently provide the new-born with synthesised vitamin K.
When a baby fasts spontaneously for one, two or three days, till her meconium comes out, she gets thirsty. When you give a few spoons of water with drops of lemon, honey or milk as most Indian rural women do, you provide her with a small quantity of foreign food carrying microbes to the intestines, which in turn induce the vitamin K that will protect the baby against any haemorrhage incident.
The big argument opposed to that simple fact is that "mother nature" provides for everything, and since her mother has colostrum and milk, these are the only food the baby should take.
I agree that the transition for the baby from the womb to the outer world should be as smooth as possible. So, I took care that my son be born in semi-darkness, in a quiet place with soft sounds to his ears and nobody around save his mother and father. He was handled in a rhythm and manner adapted to him. In the same way, I gave him this little bit of water to help his organism to adapt smoothly and in the best conditions to this world.
Nobody would protect her baby's nervous system by withdrawing any external input. The same is to be considered with her digestive system.
5- Stimulation of the mother's nipples, which in turn facilitates the expulsion of the placenta, the contraction of the uterus (so important for so many reasons), the flow of colostrum and milk.
It is very well known to the supporters of "natural" delivery that the placenta detaches spontaneously in its own time (sometimes as long as 24 hours) when the delivery has happened in a way which respects the mother's needs and instinct, and when no medical intervention has taken place for the birth (see <http://bioethics.ws/birth/clara.htm#discussion>). The early stimulation of the nipples is relevant as a remedy to traumatic states only.
The same happens with the necessary contraction of the uterus. A woman able to give birth to a baby and to the placenta without drug or technology has her uterus contracting normally. Early stimulation via the nipples is required only for those cases which have turned "medical".
Colostrum and milk come as well automatically when no external pressure interferes. In any case, the spontaneous stimulation of the nipples when the baby is hungry and sucks by himself completes the contraction of the uterus and induces the flow of breast fluids in due time.
6- It allows or facilitates the bonding between mother and child.
Both WHO and supporters of birth as a physiological event advocate immediate breastfeeding as the best way of establishing a bonding between mother and child. However, premature breastfeeding appears as an intervention -- indeed a necessary one if it is preceded with traumatic birth. It is otherwise possible to combine a natural ("delayed") breastfeeding and a harmonious, complete bonding between the mother and her newborn, even in case the baby needs to be bottlefed for medical reasons.
Breastfeeding should be allowed to happen at the moment the baby asks for it, without us deciding for her. Many factors during the delivery, but also during the pregnancy and even before, along the mother's history, will determine the baby's way of feeding. It seems that what matters is not to breastfeed sooner or later, but to feel the "right time" for each individual.
When it is not needed to balance traumatic situations, the bonding between mother and child does not require immediate breastfeeding. It requires mutual comprehension and attention, for love to blossom.
.
Initial responses:
From: HSRene@aol.comDate: Wed, 21 Apr 1999 21:56:16 EDTTo: contact@bioethics.ws
Andreine,
I found your article very interesting. As a pediatric nurse, whe teach not to give babies honey for the first 2 years of life because it can contain spores which have been proven to cause death in some infants. Just thought you would find that interesting. Maybe you could research it and do an addenum so other people aren't putting their babies at unnecessary risk.
In Him,
Rene'
From: Acornbaum@aol.comDate: Wed, 21 Apr 1999 22:37:39 EDTTo: djz@efn.org, contact@bioethics.ws
Donna, please publish my response in the newsletter, space permitting. Halle B.
With regard to the Hypothesis in Breastfeeding: I have two concerns.
One, I understand that giving honey to a child under one year of age is contraindicated, as infants are digestively ill-equipped to deal with the possible botulism spores therein.
Secondly, and let us please not underestimate the consequences thereof, Western women are already perfectly willing to allow someone else to take care of their newborns, as evidenced by the still-outrageous quantity of unsubstantiable birth interventions and unshrinking population in hospital nurseries. In my estimation, while clearly well-educated women like yourself can make a choice like this with a comprehension of human instinct at work, a widespread recommendation of this kind would be further detrimental in the U.S. and elsewhere where babies are already manhandled by "the system" and not their mothers.
One need only look to Littleton, Colorado this week to see the disatrous effects of diseases of disattachment in a country that does not trust biological instinct nor supports the true mental and physical health needs of its citizens from birth onward.
As a homebirthing mother and breastfeeding counselor myself, I can only recommend a holism of education and so your points are well-taken. Perhaps this practice is a valid part of the continuum for some cultures. Based on my own research into childbirth and breastfeeding trends in the US, I can only see misguided employment in its potential future here.
With interest,
Halle Barnett
University Hts. Ohio
From: Yelena07@aol.comDate: Wed, 21 Apr 1999 23:40:56 EDTTo: contact@bioethics.ws
I agree with what you say concerning a "natural delay" in breastfeeding. I've born 7 children and out of 7 births, only one of my children latched-on and started suckling immediately. 5 of those births were completely natural and out of hospital.I had one baby that only began nursing on the third evening after birth. I finally gave her a bottle of sugar water upon the advice of my midwife because we were afraid of her blood sugar dropping too low. After she drank some water, she spit-up a lot of phlegm and then began nursings for one believe that many times baby's just aren't ready to nurse right off and that can be okay.
Eileen Slattery, CCE
From: "Jim, Beth and Hannah York" <13thflr@omnilinx.net>To:
You have GOT to be kidding me. This goes against every single thing I have ever learned as a pregnant woman, mother, birther, and as I became a La Leche League Leader. Honey? How dangerous! Please.... just because a society without the benefit of all the knowledge possible on a subject does something, means only that one person many years ago who was considered to be wise decided that colostrum wasn't really anything important and that a baby didn't really need to be with his mother... and it stuck. It became a folkway, not something we need to do ourselves. Why not educate these societies instead? Sorry, I guess you can see how I feel about this!
Beth York
Date: Thu, 22 Apr 1999 22:40:38 -0700
From: Janie Ginder
Sorry I can't agree with your hypothesis, it seems as though you are trying to explain away "reasons" for breastfeeding within the first hour. These were not made up by "natural birth" advocates, they are simple observations of what usually happens if we keep our hands off! I attend births out of hospital, We do nothing except place the newborn infant on the mothers abdomen, dry and stimulate as needed. My observation over the past 3 years is that at 20 minutes of age most infants begin nuzzling and looking for the nipple, if they are left undisturbed they will feed until 2 hours after the birth, then they sleep. I have seen three infants who did not follow this pattern, two of these three vomited copious amounts of mucous within 24 hours and then began searching for the nipple and nursed well. I don't know if it is hunger that is driving them but who really knows? All I know is what I see and it is definately the baby making the decision we simply teach mom to follow the babies cues. Culture has alot to do with birth practices all around and the practices you are describing are cultural. The natural birth practices you describe are nothing more than respecting the infant, not overlaying our cultural beliefs and patterns on the newborn. The babies have not been indoctrinated by culture yet, I think we should listen to them!
Janie Ginder RN
From: Olallie@aol.comDate: Thu, 22 Apr 1999 23:22:44 EDTTo: djz@efn.org
My Amish ladies, when left alone, (or having birthed alone, as is the case for many women) usually delay breastfeeding for up to 24 hours. They all breastfeed, and to my knowledge, they do not have problems with either sucking, milk supply, bonding, or hemmorhage more than the usual. Interesting.
From: "Phil Watters"
It's no wonder some people are driven to distraction and end up saying "you do it your way and I'll do it mine"
At least they seem to be preventing neonatal hypoglycaemia which is about the only thing I agree with (the honey or molasses)
Phil Watters
(no further correspondence will be entered into)
From: Nleeguitar@aol.comDate: Thu, 22 Apr 1999 17:45:52 EDTTo: djz@efn.org
In a message dated 4/21/99 5:20:16 PM Eastern Daylight Time, djz@efn.org writes:
> Breastfeeding should be allowed to happen at the moment the baby asks for
> it, without us deciding for her. Many factors during the delivery, but
> also during the pregnancy and even before, along the mother's history, will
> determine the baby's way of feeding. It seems that what matters is not to
> breastfeed sooner or later, but to feel the "right time" for each
> individual.
>
> When it is not needed to balance traumatic situations, the bonding between
> mother and child does not require immediate breastfeeding. It requires
> mutual comprehension
This is the only part of the treatise that makes sense.
Early breastfeeding is associated with early passage of meconium which is associated with lower bilirubin (DeCarvalho 1980's and Yamouchi & Yamanouchi 1990). Every other mammal on earth offers her teat to the newborn; how does it make any sense to give a newborn water or honey or beikost or any other substance that may contain alien proteins which will sensitize the gut, change the intestinal flora, and/or introduce alien germs? The mother's breast makes antibodies to all the germs in the baby's environment. So baby is immunized via those wonderful IgA molecules plus all the other goodies in colostrum. No need for anything else.
Righard in 1992 described baby's innate ability to crawl to the breast and self-attach. Baby is not crawling to the kitchen to get a drink of water, but homing in to the life-giving breast. Much of the reflex activity of a newborn is organized around breastfeeding, baby's choice.
Keep it simple: human milk for human babies on their own timetable, kept close in their mothers' arms in a loving supportive environment.
Warmly,
Nikki Lee RN, MSN, Mother of 2, IBCLC, ICCE, CST
From: MTedit@aol.comDate: Fri, 23 Apr 1999 00:29:05 EDTTo: djz@efn.org
In a message dated 4/21/99 2:17:05 PM Pacific Daylight Time, djz@efn.org writes:
<<>>
You have seen the baby crawling up the mother and finding the breast and latching on. I think she is hypothesising and experiencing what she believes this is not grounded in natural birth. LOVE jan
From: Midwife@aol.comDate: Thu, 22 Apr 1999 07:48:53 EDTSubject: Food for thoughtTo: djz@efn.org
Dear Donna
And my simple thought is this there are rules and exceptions to the rules. The rule is that immediate breast feeding and breast feeding in general is best for mother and baby. The exception to this rule is that sometimes ealy breast feeding or breast feeding in general does not work, this is rare but it does happen.
No guilt no rule only an exception that needs to be placed in context.
And It is not that the natural child birth movement is pushing breast feeding
It is that the bottle industry and the medical model has been pushing the bottle
Please let's focus on finding research that documents the safety of bottle feeding instead of having to prove that breast feeding is best.
LOVE
Marina
From: JHCarlyon@aol.comDate: Thu, 22 Apr 1999 09:47:50 EDTTo: djz@efn.org
I have one big problem with delayed breastfeeding. When a baby is left alone to rest on the mother's belly without being washed or messed with immediately after birth, he/she will crawl up the mother's belly to get the mother's breasts. This seems to be nature at its finest; for if the baby is messed with in any way or if there is a delay in contact with the mother (greater than one or two hours after birth), then the baby seems to have lost this natural drive and instinct altogether. It seems like intervention to me to do ANYTHING other than help the mother pull the baby onto her belly after delivery and allow the baby to crawl up to her breasts. (See the January/February issue of Mothering magazine.)
Jessica Carlyon
X-Sender: djz@mailhost.efn.orgDate: Fri, 23 Apr 1999 08:09:45 -0700To: Soler6@aol.com
From: Donna Dolezal Zelzer
At 10:07 PM -0400 4/22/99, you sent these words singing over the electrons:
> An interesting hypothesis, but, I must say it sounds ridiculous. Having
> birthed four babies in a variety of ways (natural spontaneous, induced, etc.)
> and having breastfed all my children I would say that immediate breastfeeding
> in a natural environment is at the discretion of the baby. My first son had
> very little interest until my milk came in. My second son jumped out of my
> womb and onto my breast where he nursed for a solid hour. At nine pounds
> three ounces, he loved nursing and nursed with gusto and affection for a
> solid two years. My third son waited several hours before being interested,
> however he showed apparent hunger from that time on and was not entirely
> happy until he had a full supply of milk. My baby girl was slow to develop an
> appetite and this probably took a solid week.
> A hypothesis that I have based
> only on my own children is that each of my older children had a different
> passion for nursing and each weaned themselves when ready, however, their
> passion for nursing correlates with their like for milk and other dairy
> products to this day. My most vigorous nurser as a baby just adores milk and
> dairy products still.. My youngest son who weaned himself at thirteen months
> abhors milk and dairy products. My other son who weaned at eighteen months is
> more moderate. To me this is an interesting observation. This hypothesis,
> really tries to forge the writers birthing experience on others. Women
> really need to respect everyone's birth choices and experiences. There are
> ideal ways to birth and nurse but no right and wrong. Quite honestly in a
> relaxed environment I believe these experiences are most influenced by the
> baby itself.
But isn't that what she said?:
"Breastfeeding should be allowed to happen at the moment the baby asks for it, without us deciding for her. Many factors during the delivery, but also during the pregnancy and even before, along the mother's history, will determine the baby's way of feeding. It seems that what matters is not to breastfeed sooner or later, but to feel the "right time" for each individual."
I guess i don't see where you're disagreeing with the main idea (or what I see as the main idea.)
Donna
From: MTedit@aol.comDate: Fri, 23 Apr 1999 00:26:54 EDTTo: djz@efn.org
<< - The reflex of sucking is ensured. It is well known that the reflex of sucking is spontaneous for a mature new-born, if no drug has been given to her nor to the mother during the delivery. If this condition has been respected, there is normally no need to ensure this reflex. Moreover, in India again, ayurvedic doctors suggest putting a drop of honey on one's finger and giving it to the baby to suck and indulge the taste of sucking. Poor people who cannot offer honey give plain cane sugar molasses. >>
Donna this is terribly dangerous. Honey has been indighted with causing death via botulism in the newborn and even older babies. You need to let people know about this danger. Also NOTHING should be given a newborn baby besides breastmilk. Research shows this can cause all sorts of allergys. I haven't read the rest of her article but I would be careful with info put out there.
LOVE jan
Date: Fri, 23 Apr 1999 08:25:19 -0500To: djz@efn.org
From: David & Alison Barsi
In my own personal birthing experiences (five of them.) There was never a time when I didn't feel a compelling urge to nurse my babies soon after birth. I never had home births. All of my babies were born in a birthing room and I had "rooming in". They were bathed in a Leboyer bath soon after birth also. (That's as close to a waterbirth as I could get.) All were rather large babies, 9 to 10 lbs., and all exhibited the rooting reflex. I guess that's how I knew they wanted to nurse. They also had strong sucking reflexes. Maybe things just take longer if babies are smaller. Was the size of the babies relevant in the study?
In the women I serve as a midwife, I rarely interfere with the natural bonding process. Nearly all women, in my experience, know when their baby wants to nurse for the first time. I can't say that I would ever recommend fasting for a newborn. If anyone has seen newborn animals, one of the first things the mother does is encourage them to nurse. The animals that don't nurse soon after birth are usually the ones that don't survive. If newborn animals get weak from not nursing soon after birth, don't newborn babies, also?
I fail to see why you should ever give a perfectly healthy newborn some sort of sugary concoction when your breasts are right there, providing everything that newborn nutritionally needs. The idea seems so absurd to me. Is there any kind of cultural superstition attached to the idea of delayed nursing or supplementation?
Have you ever seen the film of delivery self-attachment? It's absolutely fascinating and truly reaffirms the belief that all healthy newborns know precisely how to nurse on their own, unaided by anyone.
Alison, homebirth midwife
Date: Sat, 24 Apr 1999 00:16:09 +0300 (IDT)
From: Judy Knopf <jknopf@bgumail.bgu.ac.il>To: obcnews@efn.org cc: djz@efn.org, lactnet@library.ummed.edu
Andreine Bel's "Hypothesis in breastfeeding: Immediate breastfeeding?" was most disturbing. What are the author's credentials?
(1) I find it most difficult to believe that she is any kind of health personnel, or into either alternative or herbal medicine, since she so strongly advocates giving honey to a newborn. Since honey is a natural, unprocessed/unpasteurized food, it is possible that botulism spores may be found in it. The human digestive system does not have the flora necessary to neutralize botulism spores until the age of 2 years, therefore giving honey to a child before this age would be extremely dangerous, as botulism poisoning has a very high mortality due to paralysis of the respiratory system.
(2) I also find it rather incredible the recommended fasting period for a newborn. No health practitioner would actually recommend this. What could it possibly be based on? In utero, the fetus gets a constant flow of nutrients, that is, food, via the placenta. After birth, which is a normal but traumatic incident for a fetus, how could additional imposed trauma of fasting possibly be justified physiologically?
(3) I do not doubt at all her comments about various cultures practicing some form of depriving newborns of breastmilk and/or colostrum. This is a well-known CULTURAL phenomenon, based on various CULTURAL taboos, myths, superstitions and whatnot. In the article, apparently the delay in breastfeeding in her argument is based on some belief about the baby expelling the meconium. Delay in breastfeeding has many cultural bases of belief, but they are all cultural beliefs.
(4) Her argument that immediate breastfeeding is the "intervention" is patently ridiculous. Certainly it cannot be denied that humans are mammals. This is by definition. The author, who claims that delaying breastfeeding is the "natural" way, would be extremely hard-put to find just one other mammalian species that routinely practices delayed breastfeeding instead of immediately making the teat available. Or one other mammalian young which, upon being delivered, does not immediately seek the maternal teat to suckle, not to cuddle.
This article was quite dangerous, not only by its proposing giving honey to a newborn, thus exposing it to possible botulism poisoning, not only by advocating an imposed 3 day fast on a newborn, depriving it of vital fats vital for the still rapidly-developing brain and vital immune factors to protect it outside the uterus, but also in attempting to deny, by using two cultural aberrations to the normal physiological pattern of birth followed by immediate breastfeeding, the mammalian imperative established over millions of years.
Judy HoltzerKnopf Sociology of Health Unit, Faculty of Health SciencesBen Gurion University Beer Sheva, Israel
Date: Sat, 24 Apr 1999 18:00:24 -0700
From: GloriaLemay
Thanks for sending out this article as a special item. I always like to read articles that are not the same, complacent, smug, all-knowing, party line views. I may not adopt, subscribe or agree with this article but it makes me stop and review my experience and ask myself "Is there something I am missing in my observation of breastfeeding that I need to re-look at in light of this material". Sometimes, it takes a very extreme or unusual thesis to ignite this questioning attitude.
I am reminded of the video of Elizabeth Noble & Dr. Leo Sorger's birth. The couple have just had a beautiful water birth and some time later are about to cut the umbilical cord. Each time they make a move to do it the baby cries out. Elizabeth's 5 year old daughter speaks up and says "He doesn't want you to cut his cord yet!" Elizabeth and Leo listen to her, wait a while longer and then ask permission of the little boy. Only when he is compliant do they do the cutting. I was very touched by this and have taken it into my practice. It had not occurred to me prior to this to have the respect to ask the baby's permission. It may be a small thing to some but it sets up a respect for the wishes of the child in everyone's mind. In Buddhism there is a saying "In the beginner's mind there are many possibilities, in the expert's there are few."
At best, all we can ever really know about human health and early feeding is a "likely story". Andréine adds another "likely story" to the discussion and it is welcome because it shakes up the ruling "likely story" which has lots of agreement but may not be the TRUTH. When I have midwifery students at a birth, I always ask them afterwards what they learned from the birth. I'm sure the students think I am testing their knowledge but it is just the opposite--I am trying to access their beginner's eyesight so that I might see the birth freshly and notice things that I have missed because of only seeing through my experienced eyes.
Certainly, we know that this whole mania of grabbing the breast and trying to shove it down the newborn's throat just so a nurse can comply with the latest thinking of "breastfeeding on the delivery table" is just as gross as taking the infant away to the nursery with no skin contact. They are just flip sides of the same coin and leave the mother thinking "something is wrong with me". I believe that skin contact with the mother is what produces the hormones to have the placenta expelled smoothly and this makes me patient to follow the lead of the mammatoto as to when suckling should begin. I like to know the baby has latched on and fed well by the 4 hr mark postpartum but, as I think of it now, that is because we are usually ready to leave by then. Perhaps I should relax more about leaving the family home and trust the mammatoto more.
Andréine's perspective is valuable because she brings to the discussion of breastfeeding initiation her personal experience, her residence in a country that is not obesity prone, her travels in foreign countries and her respect for cultural practices that differ from her own. I have seen so many things in my 23 years of practice that I started off being opposed to and then, within 2 or 3 years, had completely adopted as my own idea. I like the saying "The truth shall set you free -- but first it will make you mad."
Again, Donna, thanks for forwarding this interesting item.
Gloria Lemay, Private Birth Attendant, Vancouver, BC Canada
Preliminary remarks by Bernard Bel <bel@wanadoo.fr>
The material we have received so far is rich in content for a discussion of the challenge posed to the bioethics of birthing and childcare practices, which is based on the belief in a universal, rational and "natural" model opposed to "cultural aberrations" based on "various cultural taboos, myths, superstitions and whatnot" -- to quote an eloquent statement in the initial replies <http://bioethics.ws/misc/hypbf.htm#r14>.
Leave alone the habitual contempt for cultures outside the industrialised world, I am surprised by discrepancies between the conclusion of the original posting and the strong assertions of many replies, which make me wonder how much effort their authors had put in reading the initial posting and the source material it refered to...
Quick emotional responses to what is discarded as a dangerous propaganda (admittedly, by an ignorant European) highlight the top-down educational approach of "modern secular missionaries:"
"[They] depict a state of affairs in the countryside or among 'the poor' which morally requires and legitimises in their own eyes an active involvement. That depiction often though not explicitly constructs 'the backward' as superstitious, unwilling to respond and simply victims of their own defects, mainly a reluctance to learn and change obsolete traditions."(G. Poitevin, "Between Subaltern Participation and Democratic Cooperation", 1999 forthcoming <http://iias.leidenuniv.nl/host/ccrss/partcoop.htm>)
Andréine wrote that imposing a viewpoint and a set of practices on birthing women is a case of "hypnosis" (unfortunately changed to "hypothesis" by the list ed.). "Hypnosis" designates the state of supporters of a "consensual" practice who reject as heretical any argument questioning the rationale for their commonsensical beliefs. It is "hypnosis" because their brain cannot operate outside an assertive model -- which is accepted as "empowerment" by the development NGO culture. According to this model, a person who does not adhere to the orthodox way is certainly advocating and imposing the opposite practice on women. The same women who have been trained (by the same educational system) to follow instructions rather than rely on their own perception and experience.
(Readers of OBCNEWS might remember <http://www.bioethics.ws/power/shapiro/s.htm>, a typical instance of delusion caused by top-down communication on birthing issues.)
I wouldn't find a better word than "hypnosis" when a person who writes
"Breastfeeding should be allowed to happen at the moment the baby asks for it, without us deciding for her"
is accused of "impos[ing] [the] trauma of fasting" on the newborn <http://bioethics.ws/misc/hypbf.htm#r14>, advocating "disattachment from the mother"<http://bioethics.ws/misc/hypbf.htm#r2> and "forg[ing] [her] birthing experience on others" <http://bioethics.ws/misc/hypbf.htm#r11>.
Let us start with a discussion of elementary physiology. A recurrent argument against this "ridiculous hypothesis" (same contribution) is that all mammals nurse immediately. The original posting said:
"When we leave time for nature to work, the colostrum comes after two or three days, which is the time usually required for the meconium to be spontaneously pushed out. The baby becomes hungry because her intestines are clean and her hunger is met immediately with this highly rich food which reinforces her digestive (and immune) systems ready to receive and benefit from it."
So far, none of the persons having "seen the baby crawling up the mother and finding the breast and latching on" <http://bioethics.ws/misc/hypbf.htm#r8> took care to indicate whether this reflex was anterior, or posterior, to meconium expulsion. For this is the main physiological interpretation the author is trying to assess. The mammals we observed so far (other than humans) evacuate meconium at the moment of birth, which many human babies also do. In this case, the feeding reflex seems to start immediately. The mother who called this a "ridiculous hypothesis" was wise to report that her four babies had displayed delays in feeding "at their discretion" <http://bioethics.ws/misc/hypbf.htm#r11>, which is an interesting observation calling for more details about whether it was related to colostrum ejection.
The argument of "nature" is asserted again with statements of humans as ordinary mammals and the witty observation that "Baby is not crawling to the kitchen to get a drink of water" <http://bioethics.ws/misc/hypbf.htm#r7>... Let us stay with "nature": do other mammals use bathing tubs for birthing, do they ever bathe or wash their children? Do they take snapshots of their newborn? Do they use toilet paper or diapers? Do they wash their hair, cook their food, etc.? Conversely, how many supporters of natural birth licked their babies? Why do they fail to follow all procedures dictated by mammals? (We recently heard of a highly-educated woman who felt an irresistible desire of licking her newborn and was vehemently opposed by docs and nurses...)
Why is it that we call "natural" things consensual in our culture and reject the rest as "cultural taboos, myths, superstitions..."? (I am appalled to read a phrase like this by a member of a "Sociology of Health unit" who further dares to question the author's academic credentials! <http://bioethics.ws/misc/hypbf.htm#r14>)
No serious social scientist would feel happy with the "cultural explanation" of a practice which is prevalent on such a broad multicultural territory as the Indian subcontinent. The invariance of a practice in relation to local belief systems calls for explanations in the domain of least variance, i.e. human physiological processes. Let us keep in mind that women in villages or slum areas do not rely on knowledge acquired from mass media or formal education, but from their elders' advice and personal experience. Knowledge about birth and infant care remains "in the house" as it is not propagated (and legitimised) by men. Andréine gave the example of Bhusya Devi, a midwife in Bihar who would train her daughter in law and refuse to teach her own daughter because the latter lived in a different house <http://bioethics.ws/dais/daicomp.htm#learning>... Patterns of communication in rural India and the perception of an "elusive alien development" are analysed from insiders' points of view in <http://iias.leidenuniv.nl/host/ccrss/comcupow.htm>.
Recent publications (JPMA J Pak Med Assoc 1997 Feb;47(2):63-8; Bangladesh Med Res Counc Bull 1996 Aug;22(2):60-4; Acta Paediatr Suppl 1993 Aug; 82 Suppl 390:47-61; Indian Pediatr 1990 Jun;27(6):591-3) point at breastfeeding starting after more than 24 hours among about 70% of mothers in urban areas, while NGO studies in rural areas indicate a much higher percentage. Readers who still think this is a rare practice may check the total population of Pakistan, India and Bangladesh -- a crowd that is insane to the extent of believing it is "dirty" to use toilet paper in replacement of water...
Interviews of veteran traditional midwives in rural India <http://bioethics.ws/dais/daicomp.htm#feeding> made it clear that "delayed breastfeeding" is not a practice forced on mothers and babies due to obscure cultural reasons. Most of the interviewed ones had no explanation, while some of them had correlated the initiation of breastfeeding with the expulsion of meconium.
A question is still pending: why do all mammals (except "a few" women) immediately breastfeed? If the correlation with meconium expulsion stands, early expulsion (notably before birth) might be associated with fetal stress. Another broad justification could be the uniqueness of humans as omnivorous, the result of a long evolutional story of climatic adaptation. This might explain why the human digestive system requires a "training" which is strongly conditioned by the elaborated food absorbed at an early age. Having spent more than 13 years under a tropical climate in places where no reliable food and water supply is available, our whole family feel indebted to digestive systems that were able to cope with an adverse environment -- which was not the case with the "pampered" (= urban or foreign) ladies telling village women what they should do!
Women who experience the "slow" process of breastfeeding initiation, as we did in Europe and apparently a few have done it in North America, claim it is "natural". Whereas whenever WHO and Western-educated docs, nurses and midwives beat the drum in favour of immediate breastfeeding (as evidenced in NGO literature, the discourse of social workers and the conclusions of medical papers cited above) the rural poor perceive it as an intervention on a natural process -- "this whole mania of grabbing the breast and trying to shove it down the newborn's throat", as worded by Gloria Lemay <http://bioethics.ws/misc/hypbf.htm#r15>.
Our problem is not what the "missionaries" do at home, but with the way they are proselitizing it, regardless of the amount of free-will some birth activists claim to instil in women so that they make informed choices about birth and baby care. For historical reasons, NGO culture in India framed itself according to "the universalism of autonomy, rationality and rights" conveyed by North-American bioethics. (See B. Jennings, "Autonomy and Difference: The Travails of Liberalism in Bioethics", in R. DeVries & J. Subedi, eds. "Bioethics and Society - Constructing the Ethical Enterprise." New Jersey: Prentice Hall, 1998) The critique of NGO interventionism in developing countries is often perceived as an assault on values which North American cherish as "universal" because they reflect the laws of "nature" -- if you are not sure, read again the first paragraphs of the Declaration of Independence of the USA... However, the same people who feel offended by our words should first measure the effect of their interventions on "beneficiaries", most of whom are not able to articulate their own ideas in this school-like situation of top-down communication reproduced by training workshops. They do communicate at a personal level once a relation of confidence has been established and they think the foreign person will be able to understand their language and ideas. If "empowerment" means anything to us, it is self-reliance, not assertiveness. (See Poitevin's paper cited above: <http://iias.leidenuniv.nl/host/ccrss/partcoop.htm>)
Gloria Lemay came up with another very meaningful remark:
"I like to know the baby has latched on and fed well by the 4 hr mark postpartum but, as I think of it now, that is because we are usually ready to leave by then. Perhaps I should relax more about leaving the family home and trust the mammatoto more."
I would add to this that the deliveries in which a different timing was experienced for breastfeeding and mother's getting up (undoubtedly another controversial issue, see <http://bioethics.ws/birth/tansen.htm#getup>) were "unassisted" ones in Western Europe. Even the short visit of a medically-trained midwife in a recent delivery provoked unnecessary concerns about "delayed" placenta expulsion. (See <http://bioethics.ws/birth/clara-en.htm#discussion> and a similar situation in "The Case for Midwives" <http://www.birthlove.com/pages/midwives.html>) In Indian villages and slums, birth attendants are not dependent on tight schedules and the preset notion of an accomplished task. Gloria's remark points at the problem of transfer of responsibility to the birth attendant, which is generally not exercised in the culture under study.
While young Indian women in the upper class fashioned by the neocolonial formal education system are quick to adopt Western patterns of thought, the "backward" ones in villages and slums still rely on their own experience and sensations... Is it not precisely what the natural birth movement in the West is advocating?
I confess that after reading such a discharge of emotional reactions I have a difficulty appreciating how far this movement is breaking free with allopathic medical models of birth and health care... This paradoxical situation requires a great deal of hypnotical passe-passe to circumvent a collapse of all certitudes -- whereby "people [would be] driven to distraction" (see <http://bioethics.ws/misc/hypbf.htm#r6>).
May I give the final word to Kusum Sonavne, a Maharashtrian social animator:
"Last but not least, a critical inflexion gives bite to traditional idioms which certainly lamented for ill-treatment and harassment but lacked punch to fight back and clearly claim another justice. The present empowers the past idioms. Critical awareness instils a new breath into them. They enjoy a new span of life. The past mirrors the present, the present makes the mirror forcefully implode."(A performance capacity reactivated. <http://iias.leidenuniv.nl/host/ccrss/perfcap.htm>)
The argument of "honey as a dangerous food" will be replied later (follow link).
Bernard Bel(need credentials?) Centre National de la Recherche Scientifique (CNRS, France)Former coordinator of the "Culture, Communication and Power" research programmeCentre de Sciences Humaines de New Delhi (New Delhi) & Centre for Cooperative Research in Social Sciences (Pune, Maharashtra)
More responses
Date: Fri, 23 Apr 1999 11:59:18 -0700From: Jana McCarthy <janamccarthy@home.com>To: contact@bioethics.ws, Donna Dolezal Zelzer
I was interested in responding to your hypothesis in breastfeeding, mostly because I am a lactation consultant and work with breastfeeding mothers. I must clarify that I work with women at all stages of their breastfeeding: not only when it is initiated, but through the completion of it. I also see women with problems. I am also a nurse, childbirth educator and mother fascinated by the collection of new ideas and terribly curious!
I'm quoting here from the book, Breastfeeding and Human Lactation, by Jan Riordan and Kathleen G. Auerbach:
Prelacteal Feeds:
Many of the world's infants, even those who later will be fully breastfed, receive other foods as newborns. Of 120 traditional societies (and by inference in many ancient preliterate societies) whose neonatal feeding practices have been described, 50 delay the initial breastfeeding more than two days, and some 50 more delay it from one to two days. The reason: to avoid the feeding of colostrum, which is described as being dirty, contaminated, bad, bitter, constipating, insufficient, or stale (Morse, Jehle & Gamble, 1990).
Early medical writers in the eastern Mediterranean region (Greece, Rome, Asia Minor, and Arabia) and later in Europe--from Soranus through those of the 1600s--also discouraged the feeding of colostrum. Medical writers recommend avoiding breastfeeding for periods as short as one day (Avicenna, c. A.D. 1000) to as long as three weeks (Soranus, c. A.D. 100). Commonly, the newborn was first given a "cleansing" food designed to promote passage of meconium: honey, sweet oils such as almond, or sweetened water or wine were most often used.
In Europe, the fear of feeding colostrum may have contributed to the undermining of maternal breastfeeding--at least among the upper classes--and spread the practice of wet-nursing (Deruisseau, 1940). A similar charge has been leveled at prelacteal bottle feeds. These are commonly given in Western (or Western-style) hospital nurseries; they seem to undermine breastfeeding and to increase the use of manufactured baby milk (Verronen et al., 1980; Winikoff et al., 1986). One can only wonder if routine Western hospital practices, which include delayed first breastfeeding and prelacteal feeds of water or artificial baby milk, are technological vestiges of this widespread traditional "taboo." Not all published work supports the idea that prelacteal feeds and a delay in initiating breastfeeding reduce the likelihood of successful lactation (Richards, 1986). Ensuing successful breastfeeding may be associated with the maternal perception that prelacteal feeds are appropriate, and in positive maternal behavior following the commencement of breastfeeding: nearly constant contact with or close proximity to the infant; breastfeeding ad lib day and night; and no further use of feeding bottles (Woolridge, Greasley & Silpisornkosol, 1985; Nga & Weissner, 1986).
In evaluating a cultural practice, there are several questions to ask (Williams &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp; Jelliffe; 1972):
Is it beneficial?Is it harmless?Is it harmful?Is it uncertain?
The hypothesis of delay of breastfeeding, as a cultural practice, could be scrutinized this way.
Is it beneficial? Forcing a baby who is not ready to breastfeed doesn't seem like a very good idea. I would advocate allowing the baby non-threatening access to the breasts, allowing him/her to cuddle. When the baby is ready, the breasts are there. I don't think giving water, honey, sugar, or milk is beneficial. It serves no positive purpose.
Is it harmless? For most healthy babies, yes. For certain babies, no. Some babies are slow to pass meconium. Colostrum has a laxative property that stimulates peristalsis and therefore encourages bilirubin elimination. Jaundice is less likely to occur if feeding is not delayed. Jaundiced babies become very lethargic, sometimes choosing to sleep rather than eat, and they can be extremely difficult to rouse. In a mother who is unsure, she could confuse the baby's inability to waken with the baby's choice not to breastfeed. I've seen this. The baby was 6 days old and pumpkin colored. Mom was engorged and baby was only asking to nurse every 6 to 8 hours. This baby was hospitalized for dehydration. Delaying breastfeeding also delays reception of the immunities present in colostrum. Since colostrum (and breastmilk) have anti-bacterial, anti-fungal and anti-viral properties, and water, honey, sugar and milk may have bacteria, fungus and viruses present, it may not be so harmless to introduce those substances before the colostrum.
Is it harmful? I've seen allergic responses to cow's milk based formulas on the first day of life. And in the case of infant botulism, the only known food exposure implicated has been honey (even though world wide it is not implicated in more than 35% of cases). It is not recommended for babies under one year.
Is it uncertain? Possibly.
As to the arguments for early breastfeeding:
Sucking reflex: it is known that, for most babies, the most intense sucking reflex is in the first 20-30 minutes after birth. Why have baby suck on a finger? The breast is there and it contains colostrum!
Colostrum benefits the newborn: The statement "with no early stimulation, it takes about two or three days for the colostrum to flow" is not quite accurate. Colostrum is in the breasts during pregnancy. It is there for the baby immediately after birth. Transitional milk is present 2-5 days after birth. The expulsion of the placenta, and the resulting hormonal changes, lets the brain know to start producing milk. Colostrum lines the gut and repels bacteria, fungus and viruses.
It helps the meconium to be evacuated: Yes, colostrum has laxative properties. Your statements "As soon as it reaches the baby's intestines, it evacuates the meconium, and, in doing so, the colostrum is evacuated as well. We are left with an intestine cleaned earlier but unable to benefit fully from the colostrum." The colostrum is absorbed as it is being digested, just like food. When we are finished with food, we evacuate the waste products. Just like colostrum.
No risk of harm from foreign element: Too true. The statements you make about Vitamin K bear some research. Introducing foreign foods carrying microbes to induce Vitamin K is something I've never heard of before. I figure that colostrum, which carries no risk, can make Vitamin K just as well.
Stimulation of the mother's nipples, which in turn facilitates the expulsion of the placenta, the contraction of the uterus (so important for so many reasons), the flow of colostrum and milk: It's pretty important for that uterus to keep on contracting (for so many reasons!!). How kind of nature to fix it so that happens when the baby feeds. Double duty! And you're right, milk will come in whether the breasts are stimulated or not. But engorgement is lessened (or even prevented!)by early and frequent feeds. Engorgement can be painful, sometimes so much so that women give up breastfeeding.
It allows or facilitates the bonding between mother and child: Yes it does. But so does cuddling and holding the baby.
I agree that breastfeeding should be allowed to take place at the moment when mother and baby are ready. I've seen babies who are ready to suck at birth and some who weren't terribly interested for a few days. We just let them fool around at the breasts, hoping they're taking in a little colostrum and practicing at latching on. Since I work with so many women, I see women who've never held an infant before and aren't sure what's going on! They've been taught not to trust their intuition. My job is to encourage them to learn from their baby. And that takes time. Early breastfeeding initiation allows them to learn their baby's cues faster. Breastfeeding requires skin-to-skin contact, so important for mom and baby. I guess it's the prelacteal feeds I'm not so sure about. Maybe I'm a purist!! I think nature did a pretty nifty job when the whole package got put together. There is such a beautiful harmony to birth that it seems a shame to disrupt it with "foreign foods." The breasts are an integral and important part of the birth process.
Personally, I enjoyed the closeness and connection early breastfeeding brought. My children range in ages from 24 to 6. They were all born in hospitals. The first one was taken away from me immediately and I didn't get to see or breastfeed him for 8 hours. With the others, breastfeeding was initiated within the first hour. Duration of breastfeeding was substantially longer with the younger 7 children. Science is just now learning that long-term breastfeeding has many more benefits than short-term breastfeeding (something most breastfeeding moms could have told them). Early initiation of breastfeeding has been directly linked with longer duration of breastfeeding.
Thank you for putting forth your hypothesis. It allowed me to do some serious thinking about my beliefs and learn more about what others think. I certainly agree that mutual comprehension and attention is necessary for love to blossom. But I also think that colostrum is extremely valuable and can be part of the equation. Thanks for allowing me to air my opinions.
Respectfully,Jana McCarthy
Bernard Bel's response to Jana McCarthyDate: 27 April 1999
Thank you for your thoughtfull and well-documented contribution on this subject. I will try to be short as I wouldn't want to mobilise the space for this debate. We'll need the author's response...
I think you have done a fine work clarifying cultural issues behind this argument without being normative about your personal choice. We certainly converge on the conclusion that it is most important to "listen" to the child's signal rather than stick to rigid guidelines.
Knowing that there is a great variability in the way breastfeeding is initiated in different places of the world, and again a great variability in its actual "implementation" for each newborn, would be of great help to women who wish to feel safe not interfering with their newborn's demand.
The word "prelacteal feeding" confuses me because, both in our personal case and in the practice we described, the newborn were given a very small quantity of liquid with "a few drops" of sweeting material, whatever is available -- nothing to do with bottlefeeding, as we insisted on the fact that these babies were not feeling hungry...
> Early initiation of breastfeeding has been directly linked> with longer duration of breastfeeding.
We need more details about this study -- on what group of people it has been conducted, and whether "delayed" breastfeeding was the baby's choice or a practice imposed by medical procedures. Indian women who are not pushed either way by medical staff feed their babies for several years unless they suffer from food scarity or bad health. Our son took his mother's milk for 18 months even though he had started taking colostrum on the third day.
If the "natural birth" model pushed forward in North America tends to be so assertive on this issue, it is perhaps because its proponents perceived immediate breastfeeding as the best way of "exorcizing" a hospital nursery practice whose vested interest would be "to undermine breastfeeding and to increase the use of manufactured baby milk." By clarifying this point you provide material to look at this process from a fresh perspective...
Judy Knopf's reply (30/4/99)
From: Judy Knopf <jknopf@bgumail.bgu.ac.il>To: bel@wanadoo.fr, obcnews@efn.org, djz@efn.org
My apologies to Bernard and Andreine Bel for apparently offending them by my inquiry as to Andreine's "credentials". Honestly, no offense was meant - I was simply asking what her credentials are out of curiosity. Although American-born, I am 53 years old and have lived in Israel for 30 years, and as a lactation counsellor for the last 15 of them, I have heard and read incredible statements from doctors and nurses about breastfeeding and human milk. For example, recently two women told me that their doctors told them that human milk had no nutritional value after 9 months. Another Israeli doctor was quoted in the press as stating that "nature hints when to wean from the breast, at about 6 months. Teeth and the nipple don't go together...[by then,] breastfeeding loses its physiological advantages." >From your article and responses to responses, I rather get the feeding that you would NOT agree with this, but this is the culture in which I live. Since many of the health professionals in my culture seem to know little about lactation and human milk, I have a great curiosity about "credentials" of people from other cultures when they propose ideas contrary to cultures with which I am personally familiar, and when they propose practices contrary to what I have learned over the years as lactation counsellor. (BTW, in addition to being a lactation counsellor, I have a BSc in psychology and am studying for a Master's in Medical Science).
Judging by your response to my response, I was also unsuccessful in getting across the main point that I myself wanted to make. The position of humankind on the evolutionary scale has made all of us very dependent upon our various very diverse cultures and societies. Most of us tend to see his culture as the best, the most natural, the healthiest, and so on. You yourself (p.15) remarked in the paragraph about Western docs campaigning for immediate breastfeeding among other cultures, "...for them [the other cultures] IT IS PERCEIVED as an intervention on a NATURAL process". I meant to point out that the ways in which we perceive and relate to our environment are culturally dictated. We are creatures of our cultures. I recently read parts of "The Silent Language" by Edward Hall, an anthropologist, in which he writes of different cultures' perceptions of time. "Taboo", by the way, is not a "bad word", and neither is "myth" or "belief" when one is discussing culture. They are simply words to describe cultural practices, and are neutral, at least among social sciences. Personally, I do NOT believe that the culture I live in is the best, most natural or the healthiest, especially with a local C-section rate that went from 10% to 25% in about 5 years, the average duration of breastfeeding locally is about 4 months, and that's probably wishful thinking, and I don't want to think about smoking! Perhaps I was mistaken, but I got the message from Andreine's original message that she believed that your culture was, if not the best, then certainly better than that which you call Western, but probably mean American, cultural practices on initiation of breastfeeding. I was not being judgmental in the slightest, but I felt that you were.
I never claimed that immediate breastfeeding was "natural", but I did voice my serious doubts, based on my reading of lactation among other primates and mammals, that delaying breastfeeding is "natural", which is what Andreine claims. On the contrary, one of my most frightening cases was that of a 5 day old infant whose mother had had an emergency C-section and the infant, according to the mother, had been literally forced to the breast before they left the hospital. When I was asked to see the baby, he had completely shut down, as I had heard described by my American colleagues. The baby absolutely refused to wake up to take any nourishment whatsoever, as he had been so seriously traumatized by being forced to the breast by an overzealous nurse who knew nothing about breastfeeding.
I believe that Jana McCarthy is correct that colostrum is produced prenatally, and have heard of women leaking colostrum weeks before term. Another technical point, I believe that expulsion of meconium in utero is considered a clinical sign of fetal distress (and was the reason why my second child was induced).
I was very interested in your comments about honey. You are very lucky in having health authorities that seem to know what they are supposed to do. Once you get me going about the low standard of the Israeli Ministry of Health, I am hard to stop. When I went to the Ministry of Health, Mother and Child Health Clinic, to announce my first pregnancy, the nurse gave me a green slip for a chest x-ray. Because I had grown up in America, I had heard that pregnant women are NOT supposed to be exposed to x-ray unless the medical situation was special. So I asked what the chest x-ray was for, and was told to make sure that I did not have tuberculosis. I assured her that I did not have TB and did not do the x-ray. That was 27 years ago. Now, pregnant women are never sent for routine chest x-rays, and there are big signs in every x-ray unit that pregnant women are allowed in only with written doctor's permission. Because our Ministry of Health is what it is, I will continue to advise mothers never to give honey to infants under the age of two. Yes, you are lucky, but I think that you are probably an exception in your diligent health authorites, and therefore it is dangerous to recommend to the world at large to give honey to newborn infants.
Again, I am sorry that you misunderstood what was only my curiosity. Perhaps I was too abrupt - could we put it down to cultural difference? And could you answer the question as to Andreine's professional background?
Judy Holtzer KnopfBeer Sheva, Israel
Andréine's reply (30/4/99)
During my stay in India (till August last year) I visited villages in which homebirth had been the current practice for centuries, and I stayed long enough to interact with veteran women recognised by village communities as their experts in birth attendance. These traditional midwives do not part with their knowledge unless they are sure to be understood. None of whom ever attended "training workshops" by NGOs such as the ones Diane Smith reported in Midwifery Today, 48, pp.49-58. About these veteran midwives, Diane conceded (p.50):
"[They] remain unprofiled, don't reveal their practices and are secure in their wisdom and autonomous in their remoteness. I have yet to meet these women."
Village women were satisfied with their breastfeeding practice (the so-called "delayed" one) and, if confronted with another theory, estimated that their practice being beneficial to their children they saw no reason for changing it. All of them (in the absence of disease or starvation) breastfeed their babies for more than a year -- so did I with my son for 18 months. When asked about reasons for not breastfeeding immediately, some of them further pointed out that anyway they did not have enough of "the first milk" (colostrum) during a couple of days. I have heard the same comment by French women.
Some contributors (e.g. <http://bioethics.ws/misc/hypbf.htm#r16>) raised the point that colostrum "is in the breast during pregnancy. It is there for the baby immediately after birth." My observation and the testimonies of rural women have been that the "coming in" of colostrum in sufficient quantity takes one or two days when it is not induced by the sucking of the newborn.
It is a strange idea to believe that waiting for the child to be hungry will deprive her of colostrum. Colostrum will come and will be taken by the baby in any case, before it is replaced with milk, whether it occurs the day of birth or a couple of days later.
A French obstetrician recently said on the TV that (in hospital birth) babies are born with such a formidable amount of stress hormones, whether the delivery has been pathological or not, that breastfeeding during the following two hours is the best way of evacuating stress. While I fully subscribe to this, my reflection on the breastfeeding schedule was addressed to people encouraging -- and indeed practising -- non-medicalized birthing.
There is no doubt that colostrum being laxative will push out the meconium. However, when meconium is expelled by the baby's regular bowel contractions, the colostrum reaches an empty intestine in which it has a longer transit, which is important for its full assimilation and beneficial effect on the digestive and immune systems.
In response to the same posting by Jana, I would point out that, during the first days, colostrum does not initiate the production of anti-haemorrhagic vitamin K, which is therefore routinely administered (in synthesised form) by all obstetricians I interviewed. The production of natural vitamin K provoked by the introduction of a foreign element (in very small quantity) might be the "rational explanation" behind the observed benefits of prelacteal "feeding".
The main point in my conclusion was to suggest that breastfeeding may be initiated at the precise moment the baby demands it. In the cases we observed or were reported -- again, none of which were traumatic or hospital births -- it was also the time when her intestines were cleaned from meconium, which in turn made her feel hungry. In childhood and adulthood, the same precaution is observed by Indian people not to swallow any food in the early morning before emptying their bowels. They consider this the ABC of personal hygiene and health, and a proof that their food is proper in quality and quantity. I wonder how many of their detractors respect this simple health-preserving habit?
Condemning a custom and replacing it with another one does not improve the ability of women to act according to their instinct at the individual level, an attitude that pays respect to both mother and child. My aim in writing "Hypnosis in breastfeeding" was to propose a new comprehension of what most Western believers in "natural birthing" otherwise ignore or call a nonsense produced by backwardness, superstition and ignorance.
I have witnessed how much determination and courage Indian villagers need to protect their way of giving birth and milk against the militancy of medical-oriented, or NGO/Western oriented "birth experts" (see the MT article mentioned above). The villagers' main problem is that most of them are not able to articulate their experience and beliefs with our words. Not only they need to resist the contempt of Indian obstetricians and paediatricians doing social work for the development of rural areas, but the same undermining work is done by Western midwives and "alternative" doctors, the new missionaries of a "natural approach to birthing"... another instance of an urban elite claiming to teach (economically poor) rural people about "nature".
One should question the responsibility of inducing an habit (immediate breastfeeding as a routine) which is only a more recent belief than the one which is being ostracised ("delayed" breastfeeding). When I first heard about the benefit for the baby of absorbing colostrum in a clean intestine (as explained by the "seitai" school in Japan) in terms of strengthening the digestive and immune systems, I paid attention to what was actually happening at the moment of birth and during the following days. The seitai approach encouraged me to observe, not to follow... (See <http://www.bioethics.ws/seitai/about-en.htm>)
The problem with a normative procedure is that it is an unnecessary source of anxiety when observations do not reflect the consensus on "what is natural"...
I do not see any reason for such information to be "dangerous" or worth discarding. Serious dispassionate research needs to be undertaken instead.
I have nothing to add to the arguments on honey, women as mammals, etc. developed by Bernard (see <http://bioethics.ws/misc/hypbf.htm#first>).
Andréine Bel <contact@bioethics.ws>
From: Jana McCarthy
This debate has certainly been stimulating!! I really enjoyed it. Thanks for putting it forth. Thanks, too, to Andreine and Bernard Bel for initiating it!
I wanted to comment on something Andreine said in her reply to all of us. She mentioned that when asked why they delay breastfeeding, one of the reasons they give is that they don't have enough of the first milk (colostrum) anyway. She also said that she'd heard French women make the same comment.
Well, I hear American women make the same comment everyday!! And my job is to assure them that there's plenty of colostrum and that's all the nourishment the baby needs.
I guess some things are the same worldwide -- we all doubt our ability to provide what our babies need from our bodies, the same way we doubt that we can birth our babies without medical interference.
Jana
A brief statement about honey
Bernard Bel28 April 1999
Many contributors raised concerns about the use of honey as a sweetening component of the liquid supplied to newborns before their initiation to breastfeeding. This became an important issue although this is one option among many, depending on the place, the community, its feeding habits and symbolic representations. In spite of this, it should not be overlooked because strong signals have been heard in North America regarding infant botulism acquired from contaminated honey. Whether it is used in "prelacteal" or "postlacteal" feeding bears little relevance to this concern.
Discussing the problem in detail would by far exceed my competence, so I will give a few bits of information from local sources and outline my "bioethical" perception of normative attitudes regarding food in general.
We haven't yet seen any warning against infant botulism acquired from contaminated honey in France. A friend attending prenatal courses and reading the latest babycare books confirmed this and checked it with her pediatrician. Few cases of infant botulism have been recorded in Southern Europe (in which honey is an important product) and the current French epidemiological record of infant botulism <http://www.chez.com/guatemalt/BOTULIS.html> only mentions that "in California, it has been advised not to give honey to newborns".
In France, honey is documented in great detail for its virtues in the natural health classics. Raymond Dextreit, for instance, an authority in the field, dedicated several pages of his reference work "La Méthode Harmoniste" to the value of honey in infant food. (Search <http://www.amazon.com/> for English versions of his books.) There are divergent views among nature-cure authors, though, as honey is also charged with slowing down the digestive process.
Medical records acknowledge honey for its antibacterial and cicatrizant properties, e.g. on post-operative wound infections following caesarean sections (Eur J Med Res 1999 Mar 26;4(3):126-30) or as an ingredient of the rehydration solution in the treatment of infantile gastroenteritis (Br Med J (Clin Res Ed) 1985 Jun 22;290(6485):1866-7). A homeopathic pediatrician told us that his only reason for discarding honey in the food of infants under five months is that it is "laxative"... One of the contributors <http://bioethics.ws/misc/hypbf.htm#r6> reminded that it may contribute to "preventing neonatal hypoglycaemia."
We are not so concerned about justifying the usage of honey to sweeten herbal tea and various drinks, including the few spoons of water which our son drank before taking breastmilk. Regardless of the curative properties of honey, this may be viewed as a "cultural habit" in our area. As a matter of comparison, in India honey is rarely taken as food but it is an important ingredient of the Ayurvedic pharmacopea (a generic term for a highbrow tradition deeply rooted in popular health practices).
The problem -- I hope it is clear -- is not honey by itself but contaminated honey.
Needless to say, as traditional consumers of honey we are very aware of quality standards. France has its unique "bio" label granted by independent controls over the entire food chain, which might contribute to explain why this type of contamination has remained marginal. Outside this label, honey may contain dangerous ingredients such as traces of chemicals used by industrial farmers to repell bees at the time of cropping, or pharmaceuticals for the treatment of acarians. During many years honey disappeared from the shelve of "health food", until drastic quality certification procedures were implemented. (These are being discussed at the European Community scale. Botulism or not, I wouldn't buy honey imported from California!)
Some data. In 1989, a 2-year case-control study of infant botulism in the USA (outside California) revealed:
> By univariate analysis, breast-feeding (odds ratio = 2.9) and consumption> of honey (odds ratio = 9.8) were associated with disease,> but only 11 case patients (16%) had eaten honey.(Am J Dis Child 1989 Jul;143(7):828-32)
Several studies mention vacuum cleaner dust and soil as vectors of the disease, which reduced honey exposure to about 35% of botulism cases in a (rather old) study (J Pediatr 1979 Feb;94(2):331-6).
In Southern Europe, botulism contamination of adults is frequently associated with the consumption of meat and cheese... Unprocessed French cheese is under attack for rare cases of salmonella.
Coming to the bioethics: many apocalyptic warnings issued against food products are market-driven. True or false, any piece of news regarding infant feeding has more chance to be forwarded and amplified by concerned parents and health professionals.
Let me clarify. I am not trying to discard warnings against botulism contamination. I am just trying to understand why these are so assertive in a place and almost ignored in another one. The idea of "uncontaminated" food is quite illusory, as shown by the cases of French cheese, Italian smoked meat, etc. Southern Europe has a strong culture of pleasurable food, which implies less processing and consequently less purity. Interestingly, the "Mediterranean diet" is now praised as exemplary in the prevention of cancer, heart diseases, etc., which indicates it also makes sense to people who are not "barbarians"...
The underlying question is the way the human immune system deals with the permanent microbial "aggression" that is associated with any intake of food. Why is the immune system of "civilised" people so desensitized? My family, whose members are not vaccinated, spent many years in "risky" parts of the world, without any restriction on food or water, and never got a serious infection, if we except a resistant malaria... Other visitors, notably the younger westerners who have been (artificially) "immunized" and grew up in a protective environment, keep falling sick in India even after a long stay...
There is a striking difference between human bodies described in elementary anatomy and physiology courses, subjects of epidemiological data involved in the cost-benefit calculations of preventive health measures, and every human taken as an individual. While anatomic features may display little variance, the "history" of an individual in relation to its biological environment may have a considerable incidence on its reactions to agression.
In British Medical Journal 1998;316 (25 April) Prof. T. Hart wrote:
"The adult human composes some 1014 cells, but only 10% of these are human. [...] If only 10% of the cells in an adult human are human what on earth are the rest? The answer [...] are bacteria, fungi, protozoa, worms, and even insects. We are walking zoos."
We should therefore realise that food, drugs and vaccines are administered to the whole menagerie not just the patient... Either we accept the tempering with a biological system, and associated risks, or we trust the healing resources it as acquired in its genetic heritage and developed throughout its exposure to agressive factors. My personal choice: the thing I value most is the integrity and reactiveness of my immune system, for which medical "prevention" has nothing to afford. This choice proved right in the histories of our small family and circle of friends. Everyone is free to go the other way, with all kinds of standard preventive measures in a pasteurised world. My problem with surveys such as epidemiological records is that most of them are carried on populations whose members go "the other way"... In short, I don't consider the "average" person in industrial countries to be representative of a healthy human.
I said I might not buy Californian honey, a matter of teasing our friends overseas, but I also think they should perhaps think twice before buying imported camembert.
Banning honey, vacuum cleaners (or... breastfeeding, as shown above!) makes little sense unless full attention is paid to food quality, notably the one ingested by breastfeeding mothers in polluted industrial areas. Biological contamination is not the only issue. Traces of poisonous chemicals play a significant role in food quality, as the human body is not equipped to react in a viable manner.
An important figure (I forgot details): pollution may lessen the life expectency of a bottlefed human by 40 days whereas it takes "only" 3 days out of the life of a breastfed one. While this is another convincing argument in favour of breastfeeding, which was under attack a decade ago, these "3 days" should remind us that mother milk is not immaculate of foreign toxic elements. Consequently, it is worth looking at infant feeding as a "page" of the broader agenda of environmentalist health practice.
Bernard Bel
Breastfeeding Nemesis
This thoughtful paper by Suzanne Colson published in Midwifery Today (see on-line full text <http://www.midwiferytoday.com/articles/breastfeednem.htm>) puts the topic in a perspective akin to that of Illich's famous essay Medical Nemesis.
Excerpts:
In contrast to the medical model, Rothman (1982) extols the virtues of a "holistic, naturalistic" midwifery model that is the antithesis to the dominance, power and control inherent to the medical model. Rothman stresses that midwifery care embraces an integrated approach to women as they experience childbirth. Furthermore, this model views the female body as the norm and the woman and fetus as one. In that way, it aims to provide integrated care that satisfies the needs of both. In Britain, with the implementation of Changing Childbirth, midwives and mothers have worked together to tailor this kind of service to respond to perceived needs.
What about midwifery hubris? How much of the "man's eye view" has been integrated into the midwifery model? To address this question, let us examine some midwifery breastfeeding discourse.
[...]
The thought patterns usually associated with midwifery resourcing evoke cost effectiveness on the one hand and emphasise the acquisition of midwifery knowledge, skills, values and techniques on the other. The central role of the midwife as knowledgeable and expert implies a knowledge base, consistent advice, and the use of technology to enhance performance. In many aspects of midwifery care, this is appropriate. Concerning breastfeeding, these terms are "thinking blinders." Let us put these usual thought patterns aside.
More about vitamin K (10/3/01)
This relates to Jana's statement:
The statements you make about Vitamin K bear some research. Introducing foreign foods carrying microbes to induce Vitamin K is something I've never heard of before. I figure that colostrum, which carries no risk, can make Vitamin K just as well.
There are 3 kinds of K vitamin: K1 is found in vegetal foods such as for instance brocoli and olive oil (usually not consumed by newborns ;-). K2 is of animal origin. It is produced by the baby's intestine and assimilated in small quantities. K3 is the synthetic kind.
These vitamins may only be dissolved in fat material. This means that in order to assimilate them the baby needs fat material in her food. This raises another interesting point:
Dietary fat is essential to the absorption of VK, and VK concentrations in breastmilk tended to be greater in women who had a higher fat content in their diet. A further conclusion of the study points out that VK appears to be found in the fatty portion of breastmilk. Since the fat content of breastmilk increases with the length of time spent at the breast per feeding, I would theorize that the practice of limiting the number of minutes at the breast per feeding could be decreasing the amount of vitamin K that exclusively breastfed newborns receive.
Vitamin K in colostrum and mature human milk over the lactation period -- a cross-sectional study. American Journal of Clinical Nutrition, 1991, 53:730-35, abstracted by Althea Seaver
As to vitamin K2, it is only produced when bacteries have started colonizing the babie's intestine, which may explain the introduction of foreign elements such as goat milk with honey and a little water, a current practice on the Indian subcontinent, thereby supplying the required foreign matter, the fat of goat milk to assimilate vitamins, sugar to avoid hypoglycemia, and water to avoid dehydratation in case the baby does not want breastmilk for a couple of days. It is not evident whether the quantities of such ingredients are appropriate or just symbolic. Nonetheless, since many illiterate women claim that doing in this way will "avoid bleeding", a correlation might have been observed over centuries of this practice.
posted by De wereld van de hypnose @ 2:13 p.m.
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