This post was originally written for http://www.nurturingmumsuk.com/ 

The first few weeks are often a blur for new mums. The learning curve is steep and you survive day to day – remembering to shower and put food in the fridge for yourself if you are lucky. For those mums still in the middle of that blur, the thought of the eventual return to work can be one that provokes anxiety.

You can’t imagine how it will feel to leave this new special person in your life.

How do you people cope with drop-offs to childcare and getting back to work after potentially several night-wakings?

What do you do if you don’t want to give up breastfeeding?

As a breastfeeding counsellor and lactation consultant, I’ve been supporting breastfeeding mums on their return to work for the last 6 years and there are a few things that are worth bearing in mind.

Here are my SIX top tips for returning to work as a breastfeeding mum.

1.       Don’t think about it.

OK, now I don’t mean that too literally. My message is just that if you are going to take 6 months, 8 months or a year off work and you spend several months of that stressing about the return to work, you will be seriously missing out.

STOP yourself thinking about it too much. If you stare at your gorgeous three month old and think fleetingly, “How can I ever leave you?” (which is how nature very much wants you to feel), that is fair enough. But if you spend chunks of your maternity leave feeling anxious and worrying about practicalities, you will be wasting the special times you do have together.

This time is precious. Your baby now is not going to be the same person when you return back to work. They will sleep differently, feed differently, and interact differently. You will not be leaving THIS baby but an older one.  So get your childcare sorted (which you may well have thought about in pregnancy anyway) and other than that, there’s not too much more to do! If you intend to express milk at work, it’s a good idea to write to your employer about 2 months before you go back to work to talk about arrangements. And then just carry on as normal. If your 4 month old baby won’t take a bottle and that starts you panicking because you have to go back to work at 8 months, don’t think about it. An 8 month old baby can breastfeed when you are with them in the morning and evening, take a sippy cup, drink from an open cup – you will have options. And a four month old baby that refuses a bottle may not if you try again after leaving it for a few weeks. It’s very easy to set yourself into a panic when the truth is that things usually work out with the right information and the right support.

2.       As mentioned, speak to your employer.

http://www.hse.gov.uk/mothers/faqs.htm#q14

http://www.nhs.uk/Conditions/pregnancy-and-baby/Pages/breastfeeding-back-to-work.aspx

The recommendation is that you inform them that you will be returning to work as breastfeeding mum so they have a chance to assess your health and safety and what provisions you may need. Your employers are required to keep you safe. They also have a legal requirement to allow you to ‘rest’ as a breastfeeding mother. Sadly, in the UK, there is not a clearly established legal right to express breastmilk at work and it’s important you talk to your employer so they have advanced warning and you can come to an arrangement. Some women need to have break times re-organised or a room found. Although there is no ‘legal right’ the VAST majority of employers understand that it is in their interests to try and meet your needs and provide you with facilities. Your morale matters and a baby receiving breastmilk is less likely to suffer from illness meaning less time off work for you. There are health and safety executive recommendations and many employers understand the benefits of supporting you as much as possible. However, employers will be more likely to be accommodating if you give them warning and explain your needs clearly.

3.       Talk through your schedule with a breastfeeding counsellor or lactation consultant.

Drop-ins are not just for people with problems with positioning and attachment. It’s really common for a mum to come along a few weeks before their return to work to talk about how they hope to organise their feeding and pumping schedule and how to organise things practically. I’ve included some typical scenarios later on.

4.       Practise pumping.

Is the breast pump you are using a home something you are familiar with? Do you have a backup if you need to pump at work? Is it worth sourcing a double pump if time is an issue or even hiring a hospital grade electric breast pump for a few months which can just stay at work? You’d be looking at paying less than £40 a month (http://www.ardobreastpumps.co.uk/breastpumps_for_hire)

There are tricks such as preparing the breast using massage and warm compresses. And we know that women who finish a pumping session using hand expression techniques can increase their output considerably.

http://lllrochester.weebly.com/uploads/7/9/5/4/795404/marmet_technique_tearoff.pdf

It’s also not a bad idea to build up a bit of a freezer stash before you go back. If you start pumping for one extra session each day and storing that in a freezer bag (store them flat and build up layers of thin flat bags which defrost more easily and take up less space), you will have some wiggle room if you need it. It’s not entirely predictable how pumping will go at work and some women find that their pumping output decreases towards the end of the week and then a weekend of normal breastfeeding boosts it back up again. If you have that freezer stash, it will take away some of their anxiety.

5.       Get your kit.

So you need a pump and some bottles and some breastmilk storage bags. What else? Surprisingly not much. You don’t need to store freshly expressed breastmilk in the fridge at work if you don’t want to. You can have a freezer block and an insulated bag and put any expressed milk in there. It is fine in that for 24 hours. So if you store it like that at work, put it in the fridge when you get home, then that milk can be given to your baby’s carer for the next day.

http://www.breastfeedingnetwork.org.uk/pdfs/BFNExpressing&Storing.pdf

It’s also really important to note, you don’t need to wash and sterilise the pump between pumping sessions. Breastmilk is fine at room temperature for up to 6 hours. So you certainly don’t need to wash a pump between your 11am pumping session and your 2pm one. Lots of working mums use a technique called ‘wet-bagging’, putting a pump in a plastic bag between sessions and then putting it back in the fridge. Then simply take it out next time and wipe any wet parts with paper kitchen towel if you don’t fancy cold drips against you! This also saves precious time.

6.       Breastfeed when you can.

Your supply is more likely to be maintained if you breastfeed when you get the chance. Is your childcare near work or home? Could you visit your baby at lunchtime?  Could you work from home for one day a week for the first few weeks? You could breastfeed early in the morning, then once more at drop-off, once more at pick-up and again at home later in the evening. Those 4 feeds would be enough breastmilk overall for a baby of 8 months or more. You may not need to be carrying bottles back and forth. And breastfeeding at the weekends and during holidays will help to boost your supply.

Here are the stories of three mothers I have supported (names and some details have been changed):

Carla is going back to work full-time at 6 months. Her son is an enthusiastic exclusive breastfeeder and she’d like to avoid using formula if she can. When her son is 4 months old, she writes to her boss (she is a PA in a law firm) and explains she would like to express her milk at work. Her boss explains the company procedure of having a small office set aside for pumping and there is also a fridge available. Carla explains she intends to express around 3 times in the working day and one of those times will be during her lunch break. Her boss is fine with that. She has a double electric pump which she starts using from 4 months and she gives her son a bottle every other day to get him used to it. She finds he prefers to sit a bit more upright and usually takes 3-4oz from the bottle.

She starts solids around 10 days before she goes back to work and he takes small amounts initially and Carla knows his breastfeeding schedule will remain unaffected for a while. The week before she starts work, they visit the nursery together and he has a few hours there. He then has two trial days where Carla practises her expressing schedule and the nursery workers give him a bottle and some solids.

On her working day, she breastfeeds him as normal at 6am. She drops him off at nursery at 7.45am and offers again and he takes a small feed. At work she expresses at 11am, 1.30pm and 3.30pm. She collects her son from nursery at 6pm. He is keen to breastfeed when she arrives and they breastfeed at nursery. She breastfeeds him again at home at around 10pm as a dreamfeed.  He wakes once at around 2am and she breastfeeds him again.

While he is at nursery, the carers give him bottles and offer solids and he usually takes around 12oz in total while they are separated. As he has 3 good breastfeeds in addition to that in 24 hours, Carla isn’t worried. Carla expresses more milk at work than her son takes in a bottle at the moment. Over the next few weeks, she moves to expressing only twice. Carla ends up offering exclusive breastmilk until 12 months and then she gradually introduces cow’s milk.

Phoebe is returning to work at 10 months. She is a graphic designer and works from home with some client visits necessary around London. Her daughter breastfeeds around 4 times in 24 hours and enjoys solids which she started at 6 months. Phoebe doesn’t enjoy pumping and finds it difficult so would rather avoid it if possible. She finds a child-minder who lives near her home. Phoebe breastfeeds at 8.30am and drops her daughter at the child-minder. If she is working from home she visits at lunchtime for another breastfeed. She then collects her daughter at around 4pm and takes her home to breastfeed at 6pm and around 11pm. While her daughter is at the child-minder, she eats solid food and drinks water. The child-minder doesn’t give her milk. When Phoebe has a client visit, she sometimes hand expresses for a few minutes into a plastic bag when she can grab a private moment. This is just to stay comfortable when she feels particularly engorged. This will help to reduce her risk of blocked ducts and mastitis and help to maintain her supply. She doesn’t keep the milk. Phoebe continues breastfeeding her daughter until she is 18 months old. At the end she is only breastfeeding in the morning and evening and Phoebe doesn’t feel the need to use any hand expression when they are separated.

Catherine is returning to work at 8 months. Her son breastfeeds around 6 times in 24 hours. He started solids at 6 months. He doesn’t particularly like bottles and usually only takes around 2oz max. Catherine finds that he will take more milk from an open cup called a doidy cup. He will also more likely to take it if she mixes the breastmilk with ripe banana and makes a smoothie! Catherine gets through a lot of bananas! She works 4 days a week (and at 12 months will go back to being full time). Catherine is a teacher. Her headteacher has struggled to find her a private room for pumping but has given her the key to the medical room and if that is in use, she uses a stock cupboard and she has told staff that when her scarf is on the door, please knock! Usually the medical room is empty. Her colleagues have agreed to relieve her of playground duty while she is breastfeeding. She breastfeeds her son at 5.45am and again at 7.45am at the child-minder. She arrives at school at 8.15am. She expresses at 10.45am during morning break. She expresses for 10 minutes. She expresses again at lunchtime for 15 minutes and at around 4pm for another 10 minutes. She has to use a double pump as her pumping time is restricted. She remains at school for meetings and lesson preparation and collects her son at around 6pm. She breastfeeds him at 7pm and 10pm. He wakes to feed between 1-2am and Catherine is happy for that to continue for the time being as he feeds and goes back to sleep quickly.

With the child-minder, her son takes around 3oz of breastmilk in his smoothie, 2oz mixed into a porridge and another 1-2oz from his doidy cup. She also makes sure his solids contain good sources of fats and calcium. Sometimes she struggles to pump in her breaks as she really needs to continue working. She finds herself dipping into her freezer stash and as time goes on, the child-minder sometimes uses formula to make up the porridge. On the weekends and on her day off, he breastfeeds more frequently.  

There are many women who effortlessly combine breastfeeding and working. If it sounds hard, remember that in the USA there is no statutory maternity leave and women often return to work after just a few weeks. However they have 16% of babies exclusively receiving breastmilk at 6 months and the UK manages 1% (http://www.cdc.gov/breastfeeding/pdf/2012BreastfeedingReportCard.pdf).

Working and breastmilk are not incompatible. With modern electric breast pumps and using breastfeeding support available locally and through the National Breastfeeding Helpline, it’s never been easier. However if we could get the statutory right to pump at work it would certainly help. The charity Maternity Action (http://valuingmaternity.org/breasts-at-work/ ) is trying to get an amendment to the new parental leave bill currently going through parliament. Contact your MP if you feel the right to express at work (as exists in 92 countries throughout the world) is something UK mums should be entitled to. 

So I wrote to Lynne Featherstone, my MP, previously the government’s equalities minister.

 I said I had been concerned that the recent conversations about flexible parental leave had made no mention of breastfeeding. Perhaps a mother returning to work two weeks after birth might need a teeny weeny bit of help if she was going to make breastfeeding work – and follow the government’s own recommendation to breastfeed exclusively for 6 months? The NHS website states: “Exclusive breastfeeding (with no other food or drink) is recommended for around the first six months of a baby's life. After this, breastfeed alongside other foods for as long as you and your baby wish. This might be into their second year or beyond”.

Lynne Featherstone appreciated that breastfeeding was an important area and wrote to Nick Clegg to ask more about the government’s commitment to this issue.

Here is the government’s reply.

“Dear Lynne

Thank you for your letter of 15 November to Nick Clegg concerning breastfeeding and flexible parental leave. I am replying as this matter falls within my portfolio.

The Government encourages breastfeeding and recommends employers enable women to breastfeed as a matter of best practice. There are no plans to introduce a specific entitlement for women to take time off work to breastfeed or express milk. This is due in part to our concern about setting a time limit on the periods of time mothers will need off work, as the frequency and length of time a woman needs to breastfeed or express milk is very individual. It will depend on how easy the mother finds breastfeeding/ expressing, how many feeds there are during the time she is not with her baby and how much milk her baby normally needs to take.

Many employers already recognise the benefits that allowing their staff to take the time they need to breastfeed or express milk, brings to their business as well as to their employees, in terms of reduced absence due to child sickness; breastfed babies are generally healthier; increased staff morale and loyalty, and a subsequent higher rate of return to work; lower recruitment and training costs and an extra incentive to offer potential employees. The Government welcomes this, but believes that time off work relating to breastfeeding is a matter best left for employers and their employees to agree between themselves. Alongside the planned reforms we will continue to work with employers to highlight the business benefits of supporting breastfeeding; and promote best practice.

Under the planned flexible parental leave system, new mothers will continue to have the right to the same amount of leave and pay to which they are currently entitled.

This means that new mothers can take time off work to prepare for and recover from childbirth, to establish breastfeeding, and to remain at home to breastfeed their baby throughout the Department of Health’s recommended period of 6 months.

The decision to remain at home does not affect the parents’ right to flexible parental leave as the option will exist for the father to take leave concurrently or subsequent with the mother’s maternity or flexible leave period.

Whilst there is no specific right to time off for breastfeeding, women who return to work whilst nursing will continue to:

·         Be protected under the Workplace (Healthcare, Safety and Welfare) Regulations which require employers to provide breastfeeding women with a place to rest; and where there is any risk to the health and safety of the mother or baby, the Management of health and safety at Work Regulations 1999 and the Employment Rights Act 1996, provide that employers must take reasonable steps to avoid the risk. This can include changes to the mothers working hours or conditions.

·         Have the right to request flexible working to support them in adjusting their working pattern to accommodate time for breastfeeding and/ or expressing milk.

·         Have the right to unpaid parental leave to support them in extending the period of time they are able to dedicate to breastfeeding their baby.

In the meantime, the Health and Safety Executive (HSE) advises employers that it is good practice to provide a private, healthy and safe environment for nursing mothers to express and store their milk and publishes comprehensive guidance on how employers can meet their legal requirements: www.hse.gov.uk/mothers

I would like to thank you for bringing this matter to my attention.

Jo Swinson MP

Shall we unpick this letter?

Dear Lynne,

Thank you for your letter of 15 November to Nick Clegg concerning breastfeeding and flexible parental leave. I am replying as this matter falls within my portfolio.

The Government encourages breastfeeding and recommends employers enable women to breastfeed as a matter of best practice. There are no plans to introduce a specific entitlement for women to take time off work to breastfeed or express milk. This is due in part to our concern about setting a time limit on the periods of time mothers will need off work, as the frequency and length of time a woman needs to breastfeed or express milk is very individual. It will depend on how easy the mother finds breastfeeding/ expressing, how many feeds there are during the time she is not with her baby and how much milk her baby normally needs to take.


[How many breastfeeding women do you think have been surveyed to arrive at this opinion? 
Do you think the government is aware that a breastfeeding baby takes about the same amount of milk at 6 weeks as they do at 6 months and there is remarkably little variation? 
Do you think the government knows that the vast majority of women pump about 90% of available milk in the first 10 minutes of pumping? 
And with a double electric breastpump, this may mean that a mother of a 3 month old baby need only spent 30 minutes pumping during a working day of 8 hours? 
Talk to mothers of 3 month old babies, 5 month old babies, 8 month old babies – you’ll find that the ‘very individual’ requirements are actually pretty boringly not that individual, pretty easy to work out and that the MAXIMUM a mother may require is really not so burdensome and using that as a guideline does not result in the crumbling of an economy]

Many employers already recognise the benefits that allowing their staff to take the time they need to breastfeed or express milk, brings to their business as well as to their employees, in terms of reduced absence due to child sickness;  breastfed babies are generally healthier;  increased staff morale and loyalty, and a subsequent higher rate of return to work;  lower recruitment and training costs and an extra incentive to offer potential employees. The Government welcomes this, but believes that time off work relating to breastfeeding is a matter best left for employers and their employees to agree between themselves. 


[Which makes it sound delightfully like we all sit around a table, share a flagon of ale and come up with agreements that make everyone feel warm and fluffy. Would you like to meet the mother of an 8 month old baby who was told by her employer he was not willing to provide ANY time for expressing?]


Alongside the planned reforms we will continue to work with employers to highlight the business benefits of supporting breastfeeding; and promote best practice. 


[If an employer employs a disabled person he has to make ‘reasonable adjustments’ to accommodate that person in the workplace. This might include a change to working hours or providing a special piece of equipment. But it’s apparently burdensome and unthinkable to imagine an employer might make reasonable adjustments for weeks or months to allow a baby to continue to have access to breastmilk. A room, a fridge, ten minutes here and there. Really too hard? We don’t even need the fridge.]

Under the planned flexible parental leave system, new mothers will continue to have the right to the same amount of leave and pay to which they are currently entitled.

This means that new mothers can take time off work to prepare for and recover from childbirth, to establish breastfeeding, and to remain at home to breastfeed their baby throughout the Department of Health’s recommended period of 6 months.


[Hang on now, dear Government. So do you WANT mothers to stay home for 6 months? Do you want babies to receive exclusive breastmilk for 6 months and to continue to breastfeed alongside solids after that, or not? Or do you want mother to return to work as quickly as can be conceived – perhaps only 2 weeks after giving birth – and return to a workplace with ‘no specific right’ to breastfeed or express (your words)?
 Are we saying that breastfeeding for 6 months is a luxury some women might choose to indulge and if you want or need to return to work, hard luck? 
And don’t think I haven’t noticed that a government minister appears to have misunderstood the government’s recommendations on breastfeeding and has confused the ‘exclusive breastfeeding for 6 months’ with a recommendation to ‘breastfeed for 6 months’. I noticed.]

The decision to remain at home does not affect the parents’ right to flexible parental leave as the option will exist for the father to take leave concurrently or subsequent with the mother’s maternity or flexible leave period.

Whilst there is no specific right to time off for breastfeeding [Nope, no specific right for the mother NOR the baby. Have we read the United Nations Rights of the Child Article 4: “You have a right to special care and protection and to good food, housing and medical service”?], women who return to work whilst nursing will continue to:

•             Be protected under the Workplace (Healthcare, Safety and Welfare) Regulations which require employers to provide breastfeeding women with a place to rest; and where there is any risk to the health and safety of the mother or baby, the Management of health and safety at Work Regulations 1999 and the Employment Rights Act 1996, provide that employers must take reasonable steps to avoid the risk. This can include changes to the mothers working hours or conditions.

[So let’s get this straight, the breastfeeding mother has a legal right to ‘rest’? 
Would you mind awfully if she take along her breast pump while she ‘rests’ and pops something in a mini-fridge after she’s ‘rested’.
 But oh, hang on, people can get tired in very different ways? Getting tired is a very individual thing. That’s surely very hard to legislate when it’s all so individual but yet that one seems to have made it into law. 
Can we just declare now that the mention of ‘rest’ for the breastfeeding woman is one many of us could write essays about. It was a concept from a different world – a world before the electric breast pumps of today and the modern working practices of modern women. CAN WE SWAP IT FOR SOMETHING ELSE PLEASE?]

•             Have the right to request flexible working to support them in adjusting their working pattern to accommodate time for breastfeeding and/ or expressing milk. [Have the right… also have the right to go to our employer and ask for a special day when everyone dresses up as Spiderman. Doesn’t mean the request will be granted.]

•             Have the right to unpaid parental leave to support them in extending the period of time they are able to dedicate to breastfeeding their baby.

In the meantime, the Health and Safety Executive (HSE) advises employers that it is good practice to provide a private, healthy and safe environment for nursing mothers to express and store their milk and publishes comprehensive guidance on how employers can meet their legal requirements: www.hse.gov.uk/mothers [comprehensive guidance on how to provide a place and time for ‘rest’ – these women may even need to lie down. And “You may provide a private, healthy and safe environment for employees to express and store milk, although there is no legal requirement for you to do so”. So guidance on how employers can meet their legal requirements won’t take long then, hey?]

I would like to thank you for bringing this matter to my attention. [Thanks Jo, Hope you don’t mind if we come back to you on a few things. Here’s one thing: employers have to keep mother and their babies safe. The guidance says ‘There may be risks, other than those associated with pregnancy, to consider if an employee is still breastfeeding on their return to work. These will depend on her working conditions but could include:

working with organic mercury

working with radioactive material

exposure to lead

This list is not exhaustive (see EC guidance  for further information). You will need to consider any other risks that could cause harm to the mother or child’s health and safety, for as long as she wishes to continue to breastfeed’.

You do realise, don’t you, that a mother denied the right to breastfeed is at greater risk of blocked ducts, mastitis and possibly breast abscesses? That’s even the ones who aren’t working with organic mercury. That’s all breastfeeding mums. And that a baby whose mother ends breastfeeding early will be at greater risk of health problems? So how about we make it a legal requirement that an employer makes ‘reasonable adjustments’ to accommodate breastfeeding women?

We don’t want a legal right to ‘rest’ and lie down. We want a legal right to give our babies breastmilk if we return to work. I promise nothing will crumble. It’s not scary and it’s not hard. Let’s just focus on that word ‘reasonable’.]

Jo Swinson MP

I recently supported a mum who had some initial struggles with latching. This is what breastfeeding supporters see every day.

It’s normal for us to work with mums taking a little while to get the hang of latching and positioning. It’s normal for us to work with mums who are a bit sore.

While it may feel normal for us - when you are in the middle of that experience, it feels like the end of the world.

You dread each feed.

 You fear that things are going to get worse.

And you don’t really understand what’s happening.

Is this normal? Is breastfeeding meant to feel like this? How much pain is meant to be tolerated? When should I get support? Why can’t I work out what’s going on? Is my baby getting enough milk? When can I take him off? Is it now? Please?

The mum who I was working with had been online and tried to find the stories of other people struggling with latching. And surprisingly she found very few. There are breastfeeding stories out there but it appears many people who have struggled with latching don’t think their story is worth sharing.

However it can very extremely valuable for mums to learn that struggling with latching is normal and people come out of the other side of the experience with support and with time.

So what IS normal?

Here’s an easy rule: if you are in any discomfort, why not get someone with training and experience in breastfeeding to check your latching and positioning?

Who cares what’s normal! If it hurts, let’s check.

Better to be over-cautious and get help just in case. Far better to go to a group and be reassured in a couple of days you will feel more comfortable than continue to struggle at home and wonder if this will improve all on its own.

 In the vast majority of places in the UK, mothers can access trained support – from midwives, breastfeeding counsellors, IBCLCs (lactation consultants), La Leche League leaders, and peer supporters. Even if you are unable to leave your home, people may be able to come to you.

And in a worst case scenario, if you really can’t see someone face-to-face, volunteers on the national helplines are trained to talk about latching over the phone. That often sounds bizarre but when counsellors ask you about the placement of your cracks or damage, the shape of your nipple or how feeds feel – we are able to build up a remarkably useful picture.

Even if your tenderness is within ‘normal range’ and your latch is fine, no harm will come from getting support sooner rather than later. Don’t wait.

Before you give birth, find out what resources are local to you and make sure you know where to go in the early days.

 The truth is that some tenderness in the first few days may be normal (and that’s first few days, not weeks). Our nipples are being stretched to 2 to 3 times their natural length to place correctly beyond the junction of the baby’s hard and soft palate on the roof of their mouth. That stretching may take a little bit of getting used to. There may be some discomfort in the first 10-20 seconds as that stretch occurs. For the FIRST FEW DAYS.

But pain throughout a feed?  This shouldn’t be tolerated at any point.

What’s also NOT normal is a nipple that comes out of a baby’s mouth misshapen. If a nipple is placed correctly it comes out at the end of a feed (in the first few seconds it leaves the baby’s mouth) longer than normal but rounded at the end like a jelly tot. If it’s sitting in the soft tissue beyond that hard and soft palate junction, the end of the nipple can’t get squashed and flattened.

But if the nipple is pressed against the hard palate (perhaps because the baby’s bottom lip is too close to the base of the nipple, or the chin isn’t close into the breast, or the baby’s gape isn’t wide enough), that nipple may come out wedge-shaped, flattened, tapered like a lipstick just out of the tube or with a white stripe across it. It might also get distorted if a baby isn’t using their tongue effectively.

If a nipple comes out of a baby’s mouth like that. Or a nipple starts to get cracked and visibly damaged, then you really shouldn’t delay in getting some help.

A huge amount of people struggle initially with latching. Many of us have never seen breastfeeding up close until we come to do it ourselves. When we’re pregnant and we’re imagining breastfeeding (if we can psychologically get past thinking about the birth for a moment), we often picture breastfeeding as about ‘popping the baby on’. It’s more than that. And if we lived in a society where we had grown up around breastfeeding and seen it every day, we’d know so much instinctively.

Breastfeeding a newborn doesn’t always feel as natural as we might expect. It’s OK to admit it’s difficult and you need some help. As Rosie, one of the mums sharing her story below, says, “It was about as natural as trying to put a sock on a snake.”

However, changing a nappy can feel a bit like that too. And giving a bath can feel like trying to wash a snake with a baby sponge. We are learning new skills and that can take time.

This is one of the reasons that good antenatal breastfeeding information can be so important. And certainly why seeking out face-to-face support from a breastfeeding specialist once problems start to develop can be so crucial.

Here are some stories of mums I met on Twitter who were kindly prepared to share their experiences. 

Thank you ladies, I hope your stories inspire others:

Helen Ledger: I wish people talked about it more, I really think it’s the last taboo but it’s the most natural thing ever!

I really struggled to latch my first baby to my right breast. It started in the hospital, the chair in the delivery room just wasn't right for feeding & I couldn't seem to get the baby on properly. Then a few days in she would bring up little bits of blood & I just knew it was from me!

I have large areola but small nipples, especially the right one (hope that's not too much info) & I think the end of the nipple was just rubbing somewhere in baby's mouth.

It got to the point where I had a wound on my right nipple that was excruciating to latch the baby on to. I was told to keep trying but to be honest, the pain was so severe I would be in tears every time. Plus, the wound would open every time & I would be back to square one in terms of it healing! I was told to try to avoid expressing but I decided if I wanted to continue breast feeding, it was my only option. I expressed as often as I could from my right breast & fed from my left when baby was hungry.

Soon the wound healed enough for me to latch the baby on again & because I was at home & comfortable & could adjust my position/pillows etc., I got the latch correct, aiming the flat of the nipple up slightly when the baby went to latch on.

I went on to feed my daughter from both breasts until she was 2 years old. My husband was a great support & encouraged me to give it a month before I gave in. Fortunately, by the end of the month it was much more comfortable.

I have also been feeding my second child, who is now 9 months old, successfully.

I think we just don't have a culture of breastfeeding now. I think it should be on TV more. Women don't need to sit with their top off & their boobs out to breastfeed; it should be shown discretely on programmes of influence like Coronation Street etc.

Kate Stinchcombe:  I don't know if you need any more stories about overcoming latch problems to successfully breastfeed.

The short version is that I was trying to prescriptively put my son on to the breast without considering the position of my nipples which, kind of point out to the side! I became very sore with blisters and bits of nipple dropping off etc!

The longer version is that I had a 10lb5oz baby and a 3rd degree tear. After initial skin to skin we were transferred to a main hospital and I had surgery after which I was exhausted and we just didn't get off to a great start. The young midwife told me that the audible clicking noise was a good sign because it meant the baby was getting milk. I regret not complaining once I knew better.

I had mixed experience of support from the midwives possibly because initially I was unsure if this was the way it was meant to be. My mother failed to feed me after two weeks with the same problem so could offer no advice. I had no breastfeeding peers to call on. It was Christmas so all the support groups were shut and the NCT BF counsellor had gastric flu and was too ill to even answer the phone.

On day 8 my own midwife (who had been on holiday) advised me to express for a couple of feeds to allow myself some time to heal. It broke the cycle a bit but I was still dreading every feed.

Eventually when my little boy was 3 weeks old we saw the bf counsellor who advised me on positioning. I slowly gained confidence. Rowan started gaining weight and at about 21 days he was back at birth weight and we were discharged by the midwife. It took about 3 months for us to establish a good breastfeeding relationship. He was always a big boy and hungry but never needed formula and was breastfed until 13 months.

2 years later, I didn't really have any problems with my daughter once I remembered to position her correctly. She has a tongue tie but it never seemed to cause any problems. She's 17 months now and breast milk is still her main food.

That was quite cathartic!

Lucy McGill: Oscar was born at 39 weeks by emergency section for foetal distress. I think he needed a little bit of oxygen, but he wasn't too poorly. We were in hospital for 48 hours after the section, & during this time he appeared to feed - trying to suck at the breast, but for only 30secs or so each time. I was asked by lots of midwives why I kept taking him off- I wasn't, he kept coming off. He was screaming for most of the 48 hours we were in hospital, & neither of us slept much. I was given the 'breast is best' talk lots of times (which was frustrating as I was desperate to breast feed) and I was helped to express & Oscar was syringe fed. The general opinion seemed to be he was feeding, he was just really hungry. I couldn't wait to get home as the advice seemed to be different with every shift.

On day 3 at home the community midwife spotted that Oscar had an elevated tongue tip and every time I tried to feed him my nipple was going under his tongue. The poor thing couldn't latch at all, and other than the little bit of syringed milk, he'd pretty much had nothing at all for those first 72 hours.

Interestingly, my hospital discharge notes say Oscar was 'breastfeeding well'.

The midwife asked what I wanted to do, I said I wanted to breast feed, & for the rest of the afternoon she helped me try to latch him on. I had to hold him in a sitting position next to me, with his head level with my nipple (midwife thought gravity would help the tongue tip), and I would stroke his tongue down, and then quickly try to latch him on with his tongue down. I send hours & hours 'practising' this.

I bought a manual pump & was expressing & cup feeding. So each feed would consist of me practising the latch, then expressing & cup feeding. We'd start a feed, the process would take about an hour and a half, and then we'd have an hour or so 'off', and then start over!  By about the 5th or 6th day, we'd achieve 1 good latch or so a day; by 7th or 8th day, 1 good latch per feed; and by day 10 or so he was feeding just from me. The midwife spent at least another whole afternoon with me (during which she was ringing colleagues to pass on other home visits) possibly longer. Oscar hardly lost any weight at all - I can still hardly believe this!

We went on to battle reflux, cow’s milk allergy, blocked ducts & thrush, but I fed him for 11 months, & owe it all to that midwife (I've told her this). I'm now in my 11th month of feeding no 2 (just mastitis, thrush & blocked ducts & a bit of biting this time!), I still feel so grateful to that midwife (& my husband who worked just as hard as me during those early feeds).

I really feel so strongly that the right support at the right time is key to successful breastfeeding.  The support has to be accessible during that desperate moment - a breastfeeding group next Wednesday is no good!

Rosie Don: I come from a large family of breastfed kids, so there was no doubt in my mind that I was going to breastfeed my baby. I assumed it would be easy, second nature. I had made sure to attend a brief but informative lesson on breastfeeding at the local health centre, which focussed on good position, good attachment. I felt all prepared.

I was determined to have a very natural birth, and, due to missing my first scan, I had a slightly contested due date. Days over my due date, then weeks, then into the hospital for induction followed and my ideal birth seemed a distant dream. Well, at term plus 21days, it felt better to be surrounded by doctors than water! To cut a long story short, we ended up having an emergency C-section, and were exhausted for ages after. I think a midwife must have got Small to latch the first time, while we were still very much post-op. Then we slept.

On waking I was asked if the baby had fed yet, and when I said no, that we'd been sleeping, I was met with a concerned "she really should have had a feed by now", and of course I felt ever so guilty. So I tried to feed her, but I seemed to have too many, or not enough, arms to support her. It was about as natural as trying to put a sock on a snake. I felt a bit of a failure for a moment. She was just too exhausted to latch on, and I was too exhausted to help. The very young midwife said "I'm sorry, but... you just look so uncomfortable" to which I replied - panic very evident in my voice - "yes PLEASE help me, I don't know what I'm doing!”. I have heard some say they felt embarrassed if they had to let a midwife milk them, but I just felt grateful and relieved. Small had her first feed from a syringe.

For the 48 hours we were in the hospital, we spent much of the time skin-on-skin, bonding like crazy. We began to get the knack of this latching-on business. I remember the doctor who examined her saying there was a 'slight' tongue tie, but that it shouldn't cause much problem. Wrong! The week after we came out of hospital was torture. I had read about on-demand feeding and felt it was the best idea, but every second was such phenomenal anguish. I had had some 'advice' (??) from my partner's sister, who said breastfeeding Small's cousin was "the most painful 3weeks of [her] life". I realise now that genetics may have been a factor with this tongue-tie business.

Very soon, within a week, I had nipples cracked, scabbed, bleeding, the shape of small's palate suctioned onto the teat after a feed. I knew the nipple should be further into the mouth than that. I didn't even have any cream, had decided against shields and dummies - I was at my wit's end! Luckily a call to my health worker resulted in her dropping round free sachets of lansinoh (on a bank holiday!) and booking us in for a tongue-tie op in 3days time. The end of our trial was in sight. I couldn't wait to get us to that clinic.

The difference was incredible, after the procedure to cut small's tongue-tie. I wish that first doctor in the hospital had been able just to sort it out there and then. It's only because I was well informed that I didn't give up, and even with all the reading in the world, we all still at some point must be thinking, "Is it supposed to hurt this much?".

It's been exhausting, but so SO worth it, and we're still nursing now at two and a half years. How does it feel? WONDERFUL.

Emma Cantrell: I had latch problems with both my children. With my first I struggled in hospital with no proper help to feed, within 12 hours my nipples were cracked and bleeding. This carried on for 3 or 4 days, I was told by midwives that pain was normal. It wasn't until I told my Mum (a midwife herself) about it and showed her the deep, raw cracks and blisters that she said that it definitely wasn't normal and was a latch problem. She taught me the rugby ball hold, which helped straight away. It took three weeks of painful feeding and a lot of lanolin cream before my nipples healed and feeding was easy and enjoyable.

With my son I felt a lot more confident. However, I started feeding him holding him traditionally across my body and again, there were blisters and cracks. As soon as I saw this was happening again (whilst still in hospital) I asked to see the infant feeding specialist midwife at my hospital. She was brilliant. She helped me with lots of different postures and told me I had 'perfect nipples for breastfeeding’!! Feeding was quickly pain free and has been plain sailing ever since.

Jeanne Russell: I had extreme pain for 6 weeks.  Looking back, I can't believe I stuck with it and continued to breastfeed.  I would wince in pain and cry with each feeding.  My poor nipples were raw, scabbed and in terrible shape.  I finally attended local LLL meeting where the group leader was so kind.  She help me and another first time mom after the meeting for over an hour and a half.  She talked to us about skin-to-skin, understanding how to identify a proper latch - or break a poor latch, and in my case my daughter needed some help getting a deeper latch.  This leader gave us confidence and support in addition to the technical help.  There was no pressure at that meeting and I walked away feeling a little stronger.  From that point on, my breastfeeding experience was very enjoyable and something I became very passionate about.  My daughter nursed for a year and I cherish that time.

At some point during the following year I decided I wanted to pursue this as a potential career change and I completed a Certified Lactation Counselor program and I'm beginning to build a supportive local business. I see this path leading towards meeting wonderful women who just need what I needed in order to continue breastfeeding and enjoy it.  I'm 31 weeks pregnant now and I look forward to my next breastfeeding experience.

Louise King: Before pregnancy I had never really given breastfeeding any deep and meaningful thought and therefore had little opinion on it. ‘Bitty’ jokes and ideas of older children being breastfed made me laugh along with most other people. When I became pregnant, my understanding of the importance of breastfeeding for health benefits deepened.

During our breastfeeding session as part of our antenatal NCT classes. The question: why are you keen to breastfeed?

Out of the group of five couples we all had similar responses – ‘it’s good for the baby’, ‘it helps prevent diseases throughout life for mother and child’, ‘it’s cheaper and easier’. My own reasons were the same; I knew I wanted to breastfeed for all the right reasons, and some perhaps more self-centred – the promised weight loss and laziness essentially!

I knew of course that breastfeeding is so good for the baby, and I knew I would want to give it a good shot, but In all honesty, I wasn’t sure if I would be able to manage it, and rather than thinking I would succeed no matter what, decided to try my best and see how it went – I could always switch to bottle feeding couldn’t I?

However, I had already begun to worry about whether or not I would be able to having heard stories of difficulties from my reading up on the subject and anecdotes from friends. Especially as I have (the dreaded!) flat/inverted nipples! How would the baby latch on was the question in my head above all else, driving me to research how I could assist my unborn child so I could get breastfeeding established, and thus began the journey and the first (of many) purchases to make it all so much easier for me and baby.

#1 Nipple shells to draw out the nipple prior to birth.

I was so caught up in reading up on how to draw out the nipple I barely had time before Elliott was born (2 and a half weeks early) to entertain other common problems with breastfeeding that I had received literature about. Little did I know I would experience quite a few first hand!

Not long after giving birth I managed, with excellent midwife assistance to give E his first feed from the R side. However, getting him onto the L proved tricky. Because I’d had a c-section (Elliott was breech), I stayed in hospital for three days and had plenty of help from midwives. I was also allowed someone to stay overnight – my sister stayed the first night and without her help I don’t know what I’d have done. I remember being quite shocked at the time about the almost barbaric way some of the midwives were putting E onto my breast to help him latch but I now understand it wasn’t barbaric at all. Like us mothers, babies need to learn their own techniques too, and they do not in fact pop out and know where their mouths go.

When I got home the feeding on the R was going well but the L felt all wrong. I have a very clear memory of my Mum hand expressing my L boob in my living room to encourage the milk flow for E in front of my husband, sister, brother-in-law, niece, step-Dad and cat! My brother-in-law later asked my sister ‘was your Mum just milking Lou?” I can laugh now but at the time it really wasn’t funny for me! It was also around this time that my boobs stopped being hidden demurely but looked at and pulled around by all and sundry, something I quickly got used to.

And so the journey continued. The next stage; my milk came in. Nothing can quite prepare a woman for this biological development. Everyone talks about the Pamela Anderson effect but when it happens it’s a real shock. Having huge, hot, tender, swollen boobs doesn’t do the feeling justice. On top of this, I was still finding feeding on the L difficult, so had expressed the L boob, predominantly feeding on the R and feeling (and looking) very lopsided. When E was weighed at eight days old he had (of course) lost weight. I remember feeling so angst ridden. My hormones were going crazy, I had extreme baby blues, crying and laughing (craughing we called it) and I had lopsided tits. Plus my baby was looking scrawny. Did I grab the nearest bottle in order to push aside my fears? No, in fact I didn’t actually ever consider it. I think part of the reason is the amazing help I had from visiting midwives, my NCT breastfeeding counsellor and my family. I persisted and persisted. I bought yet more products to assist. Next on the shopping list were:

#2) Niplette to draw out the nipple,

#3) the My Breast Friend feeding cushion (with a handy pocket for storing said contraptions as well as chocolate).

And I pumped my L boob every time prior to feeding to encourage the nipple and milk.

But in my naivety I hadn’t realised was how long the whole process took. I felt like a human cow, glued to the sofa, constantly feeding. Everyone kept telling me it got quicker and easier and to make the most of it. I remember resenting being stuck to the sofa watching TV and catching up with Mad Men Season Five (yes, I take this all back now!). Plus, all the feeding on the R had taken its toll. Somewhere along the line I’d acquired an open sore on my R nipple (cue purchase #4 Lansinoh). I went to the doctor who prescribed an antibiotic cream and to return after one week if it hadn’t healed. It didn’t heal. Still I persevered with my breastfeeding, seeing how well my son was doing, gaining weight, pooing and weeing and all the other things they tell you are good signs. I went back and had my first course of antibiotics and was also advised to use nipple shields #5 nipple shields. These helped with what was now I can only describe as going between discomfort and sheer teeth grinding pain. But I still continued breastfeeding. Although hazy now (selective memory obviously), I cried about this nearly every day, my husband frequently tried to persuade me to stop breastfeeding and even my mum (a pro-breast feeder) did suggest once or twice it might not be worth it.

But I refused to give in. I have no idea where I got this belligerence to continue from but I did. Something inside me just had to carry on.

The infection and sore gradually decreased after a second dose of antibiotics but there was still a nagging soreness in my nipple, and I still couldn’t breastfeed without the shield. In desperation I made another doctors appointment and saw a different (female!) doctor who suggested it might be thrush. She took a swab and prescribed me an anti-fungal ointment, with instructions to come back five days afterwards. The cream helped but it still wasn’t right. At this point I really was at my wits end. I was in a quandary. In many ways breastfeeding had become easy, ironically feeding on the L was a cinch and Elliott was thriving. I went back to the same doctor. Although the swab had come back clear she prescribed me the one off tablet for thrush. Within twenty-four hours I had no pain, no pulling sensation, no gut-wrenching trauma and within forty-eight hours I was nipple shield-less! I have not looked back since, and everything everyone said about breastfeeding came true. It is so so easy. No sterilising, no warming, no getting up in the night to get things ready. A piece of piss if you will. On top of this, my son had doubled (yes, doubled!) his birth weight in three months. I did that – me and my boobs.

When I started breastfeeding, even before all the issues, I didn’t know how long I’d carry on for. When things were though I thought maybe six weeks. Then it got easier and I thought, ok, how about three months. Then it got easier still and seven months along we are still breastfeeding, with four teeth in his mouth too.

I don’t now question when I’ll stop. I don’t really think about that I just go with the flow. From someone who laughed at breastfeeding beyond babyhood I do wonder if that might be me. Breastfeeding is so much more than just food; it’s a huge comfort and an incredible bond between baby and mother. I also now understand why the long feeds when the baby is first born really should be cherished; if nothing else nowadays E is so quick the chance of me watching a programme would be a fine thing!

I know breastfeeding is really hard, and without doubt the fact that I have a family full of breast feeders plus positive midwives on hand made my journey easier in many ways, in other ways it was bloody gruelling but I got there and I’m really chuffed that I did.

I received a quick reponse from Lynne Featherstone that was pretty impressive. She said she appreciated my concerns and attached a letter she'd written to Nick Clegg.

In it, she mentioned mothers giving up exclusive breastfeeding due to insufficient pumping breaks and reflected on the possibility to statutory pumping breaks being introduced as part of the flexible parental leave proposal.

It'll be very interesting to see Nick Clegg's response. Where does he go to answer those questions and will he appreciate that this issue can't simply be about employer discretion if new mothers really are going to get back into the workplace as early as he would like them to?

The infant feeding survey fully published on the 20th November revealed only 19% of mothers had resources in the workplace to express and maintain their milk supply.

Flexible parental leave is unlikely to work for anyone if families are being asked to choose either a return to work or a continuation of breastfeeding. No family should have to make that choice in a world of modern breast pumps, fridges and knowledge about the benefits of breastfeeding.

I'm a lactation consultant and breastfeeding counsellor and I run 3 breastfeeding support groups in West Haringey on a voluntary basis for Haringey infant feeding service (Stonecroft children's centre, Rokesly Avenue CC and Highgate Family centre) as well as supporting on the National Breastfeeding Helpline and through my private practice in families' homes.

I'm also on the Central committee for the Association of Breastfeeding Mothers (a charity who train counsellors and run the national breastfeeding helpline alongside our own national helpline). I'm also on the DH breastfeeding stakeholder's committee.

I'm waiting for breastfeeding to be mentioned in the discussions about flexible parental leave and I'm increasingly horrified to realize it isn't being.

If a mother returns to work at 2 weeks or even 2 months, what are the chances that baby will still be receiving breastmilk exclusively? Who is assessing the likely impact on breastfeeding rates across the UK and the long-term health implications?

I frequently work with women transitioning to work and asking about how to express milk at work and liaise with their employers. Last month, a very typical conversation: a mother's employer would only allow her 2 fifteen minute pumping breaks in addition to her lunch hour. This wasn't sufficient to maintain her milk supply. She was ending exclusive breastfeeding. Her employer is under no obligation to consider her individual situation, nor age of her baby nor offer anything other than 'rest breaks' described vaguely under Workplace Regulations. Any other requirements to allow pumping are simply HSE recommendations and have no legal status.

How many times will a mother of a 1 month old baby need to express during a working day if that baby is to remain exclusively breastfed as recommended? Typically every 3 hours as an absolute minimum. She will need access to a good quality pump (which will be expensive), storage facilities and a place as well as a time.

The key risk time for a mother to develop mastitis is 3-8 weeks post-partum. Insufficient pumping is likely to put the rates of mastitis and subsequent breast abscesses through the roof.

I'd like to know who is considering these sorts of issues as we encourage mothers back to work with sore nipples (typically in my groups, a mother will still often be struggling with latching baby on the breast for the first 4-6 weeks). Employers are not ready to incorporate even mothers breastfeeding at 6 months into the workplace. We do not have the American model where employee milk expression is the norm. The current guidance given to employers and the current obligations employers have towards breastfeeding mothers is laughably insufficient if these changes go forward.

I know from my contact with the DH through my participation in the breastfeeding stakeholder's committee that breastfeeding policy and leadership is in a state of 'flux' to put it politely. If these issues aren't considered now as we move forward with flexible parental leave we will have a generation of babies who are not exclusively breastfed in their first few months. Rates will crash after all the hard work of the last 15-20 years and infant hospitalisation in the first 12 months for gastroenteritis and respiratory infection with increase alongside increased risk of adult health conditions in the decades to come. The money that will then drain out of the health service could have been usefully spent educating employers, providing appropriate facilities for pumping and changing employer requirements for facilitating the opportunity for doing so.

Parents have rights to work and earn their living. What are the rights of the infant?

I was honoured to be asked to contribute an article to the blog of the International Lactation Consultant Association. 

Yesterday I was featured on an episode of the US radio/ podcast 'The Boob Group' on the subject of sexuality and breastfeeding. The Boob Group is produced in San Diego and their programmes cover a wide range of breastfeeding issues. Recent programmes have looked at hypoplasia (insufficient glandular breast tissue) and tight frenula (tongue ties) as well as breastfeeding expectations when your baby is a certain age. It's a useful resource.

(Presented 16th June 2012. Birmingham)

My background is in primary school teaching and, as a Year Six teacher and Deputy Head, I was responsible for the delivery of the Sex Education curriculum.  My embarrassment threshold is HIGH when it comes to talking about sex, which is certainly useful for the purposes of this study and talking about it in front of 120 or so people.

What inspired me to look at this topic in the first place was a conversation I had on the phone with the mother of toddler still breastfeeding at night. She was explaining that night feeding and co-sleeping was beginning to impact on her relationship. And in a millisecond I made a whole bunch of assumptions. I thought that perhaps she was getting pressure from her partner; that he was unhappy about the lack of sex but maybe she would have been happy to continue with the current situation. A whole bunch of assumptions arose from personal experience, cultural messages and who knows where. But it turned out she was miserable as they were only managing to have sex 2 or 3 times a week and this push was absolutely and definitely coming from her.

I wanted to explore how women were balancing their roles as a sexual partner and a breastfeeding mother. I wanted to look at the experiences of breastfeeding mothers and find out more about the variety of experience. I looked at parenting forums. I read books aimed at new mothers like Gina Ford’s ‘The Contented Mother’. I read about the Gogo women of Tanzania and swapped emails with a doctor working in Papua New Guinea.

I thought my talk was going to be about how breastfeeding changes sex.

But the more reading I did, the more I became convinced that the crucial issue is not how breastfeeding changes sex but how attitudes to sex in our society impacts on breastfeeding. How sexualisation in our society impacts on the work we do, how it impacts on the choices mothers make – to feed in public, to continue breastfeeding, to exclusively breastfeed, to breastfeed once back at work.

And if we are to increase initiation rates among certain groups – women under 20 for starters – we need to understand the fundamental role sexualisation has to play.

We live in a society which has lost sight of the primary function of the breast.

We live in an extraordinary culture in extraordinary times.

Spend time looking at our society’s perception of breasts and messages about breasts and it’s frankly surprising our breastfeeding initiation rates are even what they are. The 2010 UK infant feeding survey preliminary results show they are up to 81%.

However if look further, and these results are from the 2005 survey, we have 45% exclusive breastfeeding at 1 week, 3% exclusive breastfeeding at 5 months. At 6 months, only 25% are doing ANY breastfeeding.

Yes, it’s about lack of support to breastfeed, lack of information, lack of good quality antenatal education, overstretched hospital- based and community- based healthcare professionals, lack of breastfeeding knowledge from doctors. It’s about many many new families simply not knowing why exclusive breastfeeding is recommended ahead of any breastfeeding.

It’s about all that.

But I’m also going to argue that the significant drop-off as we approach 6 months is also about women struggling to integrate their roles as a breastfeeding mother and a sexual partner, or even a woman, in this society.

In our society, the nuclear family is on a pedestal. It’s isolated and centralised. The couple is the focus. The extended family, as we hear so often, is largely a thing of the past for most families living in the UK. The average working father who has 2 weeks paternity leave and then returns to employment, who may have very few other new or changed relationships or links to the ‘baby world’, comes home to this central relationship. And the strong message is that a successful relationship is a sexual one.

As breastfeeding professionals and support volunteers, we’re used to debriefing our breastfeeding our breastfeeding experience. But when it comes to sex and libido, a discussion is not encouraged.

We may assume our experiences are normal. But we need to reflect on the variety of experiences women have. The new mother not feeling sexual may feel pressured and uncomfortable but my survey revealed just as isolated is the sexual breastfeeding mother – one described herself as a ‘freak’. Is society comfortable with a woman who is simultaneously breastfeeding and sexual? Are we allowed to talk openly about that integration?

When we talk to mothers about co-sleeping, decisions to wean, evening cluster feeding and the 4 month sleep regression – how often might sex be an unspoken part of that conversation?

As breastfeeding supporters we often think it’s living in a bottle-feeding culture that makes our work hard - the dolls that come with toy bottles while a doll marketed as having any connection with pretending to breastfeed is more likely to provoke an article in the Daily Mail. Formula companies pour money into marketing their products right up to the limits of UK legislation and often beyond. Pregnant mums are signed up to clubs - and logos and images from formula companies get into their homes and their consciousness. Formula companies offer ‘information lines’ or promote forums. Pre-schools may remove feeding bottles from home corners these days but no conversation occurs of what norms of feeding are so children simply pick up glue sticks and continue ‘bottle feeding’.

As Kathy Abbott mentioned in her presentation at the Gold conference this year, bottle feeding does fit with our culture – a culture that values privacy, control, measuring, and compartmentalisation. And when only 25% of mothers are doing any breastfeeding at 6 months, this is not just about perceptions of cultural norms. This is about actual norms. 81% of mothers initiate breastfeeding but that may only be a lick of a nipple in hospital. Something else is happening in the weeks that follow. When mothers get a baby home and live their relationship with their post-natal body surrounded by our culture, something is going on. Women are making feeding choices based on cultural messages about sex and their bodies and womanhood.

If we can’t necessarily control these messages, at least we can encourage a dialogue about them.

Our society bombards us with images of the female body. The rise of the celebrity magazine is a phenomenon of the last decade where body fascism has been taken to new levels. Women are celebrated for weight loss – but you can’t be too thin and unfeminine and they vilified in the next breath if an inch of stomach flops over the top of bikini bottoms when an individual sits down. The window of ‘acceptability’ seems frighteningly narrow. There are television programmes about looking good naked, having embarrassing bodies and the reality show with groups of young women largely defined by their surgery. The perfect female body is expected to have ‘tight abs’ and the sexy rounded stomach of Marilyn Monroe is a distant memory.

The overriding message is that breasts are for male attraction and female bodies are for male attraction. As breastfeeding advocates, we write our letters about misleading formula advertising but we also need to understand that our work is also influenced by the rise of the photo-shopping, body image obsession.

When women fall pregnant, we expect them to make a dramatic mental shift. We expect their partners to make a mental shift and reject decades of messages about what the breast is for - men who like no other generation before have been exposed to images of the sexualised breast through easy access to pornography, advertising and celebrity.

And we ask women to feed exclusively for 6 months or to 12 months and beyond. While at the same time, even those of us working in breastfeeding support do not openly talk about how to incorporate sexuality and breastfeeding.

We ask them to make this dramatic shift on the basis of some colourful leaflets often lacking in  evidence-based detail, some conversations with overworked healthcare professionals and a newspaper industry that relishes an opportunity to debunk the breastfeeding ‘myth’.

How many antenatal classes ask new parents to reflect on breastfeeding and sexuality? And in how many classes are teachers terrified to dwell on a topic that might be seen as ‘difficult’ when the focus is on desperately encouraging new parents to consider breastfeeding? The new government programme of antenatal parenting classes (‘Pregnancy, Birth and Beyond’) does touch on some interesting feeding issues such as the risks of formula. It also asks parents to consider the impact of parenthood on their relationship.

It would be nice to imagine at some point, we could talk about sex and breastfeeding. The sum total of information currently seems to be ‘if you’re worried about leaking during sex, you can wear a bra and breast pad’. But what if you’re not worried about leaking? What if your partner likes it? What if he’s struggling with the image of breastfeeding in general? Is he allowed to talk about that and say that out loud? Who can these couples talk to?

Is anyone sitting around with a group of new fathers and asking them why oral sex might be acceptable but a taste of breastmilk is a difficult thought? These are conversations that need to be had.

Think about the teenage mum born in the mid-1990s. What messages have she and her partner received about breasts their entire lives? We often remark that those working with teenage mums will need to anticipate they are likely to have more body issues. But perhaps we can’t assume this current generation will ‘grow out of’ these messages. Maybe if we don’t start to reflect on the implications of the new body image obsession for breastfeeding, a dip in breastfeeding rates is ahead as these women enter their 20s and 30s.

So how do breastfeeding women feel about sex and how can we find out? We need to remember that the population of breastfeeding counsellors and supporters is unlikely to be representative of all women who breastfeed. Most of these women will have fed for a minimum of 6 months in order to undertake training with a breastfeeding organisation. Perhaps these are the women who did ‘integrate’ those sides of womanhood. Maybe they rejected the cultural norm and embraced the biological one.

Or perhaps we didn’t. Perhaps we didn’t manage to be simultaneously breastfeeding and sexual. Perhaps breastfeeding just mattered to us more and we stuck it out.

I carried out a survey of 588 women. They largely came from Twitter, mumsnet and netmums. It’s probably true that if you are struggling to feel sexual the appeal of answering questions on some lactation consultant woman’s bloody survey is small. I tried to make this point and certainly some of the women struggling did come through.

It’s also the case that a high proportion of natural term breastfeeders came through and immediately this means the survey cannot be representative of breastfeeding mothers as a whole – that world where only 25% are doing any breastfeeding at 6 months. The survey is not a great truth but it did throw up some interesting points.

I asked mothers, ‘when did you first have sex after the birth of your last baby?’

If you are a breastfeeding mother reading this, what’s your answer to that question?

How do you anticipate the 588 mothers answered? Do you think you were typical?

The results: When did you first have sex after the birth of your last baby?

 (These figures are actual numbers and not percentages.)

Less than 2 weeks: 15

2-4 weeks: 68

4-6 weeks: 96

6 weeks – 3 months: 191

3-6 months: 91

6-8 months: 30

8-12 months: 17

12-18 months: 6

18 months+: 7

Not yet: 67

The ‘Not Yet’ figure also includes mothers with babies under 3 months.

It’s clear that for the breastfeeding mothers responding to my survey having sex under 3 months was normal. And in fact having sex under 6 weeks is pretty normal.

Of course, this doesn’t tell us under what circumstances this sex occurred. Was it enthusiastic or dutiful? One mother contacted me to explain how concerned she was about the phenomenon of health care professionals advising couples to have sex before the 6 week check to ‘test things out’. She was considerably damaged by her birth and followed her instincts not to try, despite a strong urging she should. I wonder how many others don’t follow their instincts.

My survey population were breastfeeding for a long time. Huge numbers were breastfeeding for 24 months plus. Half of respondants had fed for more than 18 months. Perhaps these are the women with the partners who either value breastfeeding enough to tolerate what they’re not comfortable with or they are comfortable – and these women can be simultaneously sexual and breastfeeding. They are rejecting the cultural ideal of the non-sexual mother of an infant.

I asked women how they felt about their breasts being touched during sex.

Any breast contact is popular: 125

Breast contact is OK but I don’t like my nipples being touched: 123

Varies from time to time: 172

Prefer breasts not to be touched during sex: 160

This amount of variation was also reflected in Ann Sinnott’s results when she did her own survey for her book, “Breastfeeding Older Children”.

When Alfred Kinsey undertook his research on female sexuality in 1953, 50% of women enjoyed breast stimulation. However 98% permitted the touching of breasts and 87% permitted oral contact.

It’s interesting therefore that some of society’s discomfort around breastfeeding – and breastfeeding older children especially – is the perception that the act itself is a sexual act. Not only is that untrue, research suggests that even if George Clooney was involved it wouldn’t automatically be a sexual experience for the woman.

Are women tolerating breast contact or even sex unhappily? Are they dutiful wives forcing themselves to get ‘back in the saddle’? Are they having some sort of ritualistic sex to prove something almost as the Gogo women of Tanzania have a ritual act of sex between 3 and 4 months post-partum (and then they remain celebate for the rest of their breastfeeding experience).

Are women with biologically low libidos having dutiful sex?

I asked women if they were happy with their sex lives.

Yes, very: 80

Yes, pretty much: 198

No, I wish I had sex more often: 235

No, I wish I had sex less often: 11

No, unhappy for other reasons: 35

I think those results would challenge the notion that these are women reluctantly having dutiful sex.

The open-ended questions revealed a huge variety of feelings about sex and body image. Some women felt empowered and came alive with breastfeeding, after decades of perhaps feeling negatively about their bodies. Others were feeling self-conscious and uncomfortable.

I aksed the question, ‘How has being a breastfeeding mother affected your self-image and feelings about your body?’

 Among the huge variety of comments given were these:

“Although my OH finds my changed figure wonderful, I am far less confident in the initiation of sex and also (sorry if TMI) I am limited in choosing different positions due to leaking. Niiice :)”

“Given me confidence in body’s ability, which has knock on benefits for sex. LOVE my bigger boobs!!”

“We usually have intimate time soon after baby goes to sleep. I usually nurse him to sleep so my breasts look ‘deflated’ and I usually feel too self-conscious to let them hang down, so I prefer to lie-down or keep a shirt on.”

“It has de-sexed my breasts.”

“I want to continue bf but my husband is desperate for me to stop.”

“I am here as a carer, not  a lover right now.”

The impact of breastfeeding was often over-shadowed about a mother’s views about her general post-natal body. Many women commented on feeling self-conscious about their stomach area or their weight gain. This is also often reflected when you talk to new mothers self-conscious about feeding in public. If the concern is about nudity, it’s often not about breast exposure but ‘belly’ exposure.

I asked women about their libido.

How do you feel breastfeeding has affected your libido?

Libido is greater now that I am breastfeeding: 25

Libido is the same as before I was breastfeeding: 163

Libido is lower but difficult to judge whether this is down to new parenthood or breastfeeding: 328

Libido is slightly lower and I feel this is down to breastfeeding: 19

Libido is significantly lower and I feel this is down to breastfeeding: 60

We’re often quick to think libido is about biology and hormones. We talk about how lower oestrogen levels affect vaginal lubrication. Or how libido might be impacted by an overabundance of prolactin ( a theory mentioned by Ann Sinnott). Clearly it’s difficult to separate factors and new mothers themselves can’t.

However if only 3% are exclusively breastfeeding at 5 months, are depressed oestrogen levels continuing as an issue for many? And if you are breastfeeding beyond 18 months, prolactin levels are not likely to be remaining at a constant elevation.

It appears to be coming back to culture again. Surely repressed libido levels are also about women not seeing themselves as sexual while they are breastfeeding. They are not fitting society’s ideal of sexually attractive woman. A society that values the non-functioning breast.

These days it appears that for many, the augmented breast is the ideal breast and its purpose is to attract the male gaze.

This year marks the 50th anniversary of the first ever silicon implant surgery in Houston, Texas. Augmentation surgery costs approximately £4000 and implants last around 10-15 years. It’s the most common breast surgery with women making up around 90% of the population having cosmetic surgery.

Obviously there are women who use implants in reconstructive surgery and women with severe asymmetry who feel augmentation surgery is hardly about trying to look like Pamela Anderson. But for the majority of women, this is about feeling inadequate with their natural breast size and feeling society expects them to look different.

From 2009-2010, augmentation surgery was up 10%.

From 2002-2007, it was up 275%.

(http://www.guardian.co.uk/news/datablog/2012/jan/30/plastic-surgery-statistics-uk)

Rajiv Groover, the secretary of BAAPS (British Association of Aesthetic Plastic Surgeons) feels this is down to ‘raised awareness of the procedure and media exposure’.

In our current society, the separation of the breast and its biological purpose is pronounced. While it’s true that many women with implants go on to breastfeed successfully (Pamela Anderson among them), if you look at the literature given to women prior to surgery this is barely mentioned by clinics and organisations and sometimes breastfeeding gets NO mention in a leaflet focusing on breast surgery for pre-menopausal women. Some procedures may leave ducts intact but damage occurs to the fourth intercostal nerve with incisions that impact enormously on successful breastfeeding as the milk ejection reflex and release of oxytocin hormone is hindered.

Ironically, if we study the shape of the augmented breast it is an engorged and full breast that very much resembles the breast of a new mother. This is the sexy image.

Picture Pamela Anderson running slo-mo down her Californian beach.

But the moment we add a drip of milk to that breast, it is immediately desexualised for the vast majority in our society (expect for the small group who reach my blog using certain search terms – you know who you are). The sexy breast is overwhelmingly the non-functioning one.

We may think, ‘Oh come on! Surely men are attracted to that type of breast precisely because it suggests fertility and provision of milk? Aren’t they just all cavemen looking for successful mates?’ That isn’t the case.Cultures vary enormously in their attitude to breasts and for many the breast simply isn’t sexual. Kathy Dettwyler in her essay, ‘Beauty and the Breast: the cultural context of breastfeeding in the U.S’ published in the wonderful book, ‘Breastfeeding: Biocultural perspectives’ emphasises the fact that this is not the default setting for all human beings.

In the 1950s, the anthropologists Ford and Beach studied 190 cultures worldwide. Of those 190, 13 found breasts sexy.

9 liked large. 2 liked long and pendulous and 2 liked upright and hemi-spherical.

I had an interesting chat with ABM mother supporter, Yolanda Forster, who is originally from Belize and remembers from her childhood, women from Southern Belize with exposed breasts who only covered up as the roads going South became paved and social mobility increased. Even today she feels that breasts are not the ‘big deal’ for many Belizeans that they are in other Western cultures and breastfeeding is the norm.

The battle to integrate the dual functions of the breast is not being fought universally.

Kathy Dettwyler says, “Most Americans view Chinese foot-binding as the barbaric practice of backward people. Yet breast augmentation surgery is essentially the same thing. A perfectly healthy, functional organ, the breast, is mutilated through surgery into something useful only for male sexual pleasure.”

And, as she points out, if a cultural view exists that breasts are primarily sexual objects this impacts on whether older children receive breastmilk, whether public feeding is acceptable and the compatibility of breastfeeding and the workplace. Do women feel comfortable discussing a topic potentially laced with sexuality with their employers and colleagues and bringing something ‘intimate’ into their place of employment?

As Kathy Dettwyler suggests, the realistic aim is not about to be asking everyone to suddenly stop finding breasts sexy. However it’s useful to recognise this as a cultural attitude if the biology is at least going to get a look in.

A leaflet in pregnancy about how lovely breastfeeding is and with references to reduction in ear infections and hospitalization is unlikely to win over decades of social conditioning.

We know that culture is bombarding us with messages about body image and attraction. If you look at the government inquiry into body image last year led by Jo Swinson m.p. and the research being done at the University of the West of England, Britain’s body image is in crisis.

We all tut when we hear of 5 year old girls worrying about being fat. Or we see the bikini tops marketed at 3 year olds.

But consider the implications for breastfeeding in decades to come. Currently, half of all 16-21 year olds would consider cosmetic surgey (University of the West of England research).

There’s a world of ‘fat talk’ where being feminine means control over food. When slim is the aim and the ideal and flat ‘abs’ is increasingly a focus, the post-natal woman is likely to feel excluded. And when overall weight loss occurs, breasts often diminish so augmentation becomes more of a requirement for many women wanting to attain the ideal body shape.

Susie Orbach wrote ‘Fat is a Feminist Issue’ in 1978. She’s currently working on a research project on the transmission of body image from mothers to daughters. She’s pushing for midwives to get involved. She says, “New mums are caught up in problems with their own bodies when they’re bringing a new body into the world. We need a counterpoint to the nonsense that we should have a pre-pregnancy body 6 weeks after having a baby or ever.”

(http://www.guardian.co.uk/lifeandstyle/2012/jun/10/body-image-anxiety-eva-wiseman)

When it comes to considering the forces against women breastfeeding to 6 months, it’s also worth mentioning a theory put forward by a man called John W. Travis and others. This theory is also touched on by Ann Sinnott in ‘Breastfeeding Older Children’. It’s one of those theories that makes for uncomfortable reading. It makes most of think, ‘mmmmm…uhhhhh…rrrreally?’ but it’s worthy of mention.

The theory suggests that the current generation of daddies of breastfeeding babies largely grew up in the 1970s and 1980s and were unlikely to have been parented according to the biological norm. This may impact on their ability to accept their sexual partner as a breastfeeding woman.

In his essay, ‘Why men leave – a hidden epidemic’ (2004), Travis states:

“As infants, most men in our culture have been bottle fed and subjected to other culturally-endorsed patterns of normative abuse, such as sleeping alone or being left to cry when their needs weren’t met. It’s no surprise, then, that most of the unbonded boys in our culture grow into men who spend a good deal of their time unconsciously seeking (and fueled by advertising that prominently features the breasts they were denied) a mommy-figure to provide them with the nurturing they were denied. ..When our “mommy” gives birth and suddenly turns her focus toward her newborn, we usually lose much of the nurturance we were getting from our partners.”

Mmmmm…uhhhh…really?

It’s a possibility.

A Breastfeeding Network supporter made an interesting point to me at the ABM conference. She suggested that perhaps this sometimes comes down to whether women feel that sex is about ‘giving’ or receiving. If a woman ends a day feeling ‘touched out’ and feels that sex is yet again about meeting someone else’s needs and giving yet more – that feels very different than if sex is a time ‘for her’. For some women, sex will be a time to feel pampered, loved, cared for. Not a time to do yet more ‘giving’ but a time for loving ‘receiving’. So perhaps the couples that move forward with successful integration are simply the ones where the men are better lovers and better communicators and better at being skillful smooth operators?

Too cheeky?

The breastfeeding supporter didn’t mean to make an overly-simplistic point. She was just touching on the idea that couples who already possess a healthy mutual communication around sex are likely to find this period easier. Of course, we need to be sympathetic. Men struggle during this time too. My survey identified many couples where a woman was feeling confused and rejected and as with women struggling with sex, men can struggle for a host of different reasons. Sometimes women in the survey were feeling desperation and described how their husbands were uncomfortable about their lactating breasts or their change in body shape. How new fathers feel about sex in the post-partum period needs to be examined in more detail and can really only be touched on in this discussion. My work also failed to examine the impact of breastfeeding on lesbian couples.

One thing that seems to come across strongly is that young men and women often struggle with the notion of the lactating breast before they become parents themselves.

The discomfort around breastfeeding in public and the ‘ewwwwww!’ factor that surrounds breastfeeding isn’t always to see. As with racism, MOST people who are revolted by breastfeeding understand this is perhaps not the modern acceptable view so tend to express their views in private or unconsciously or quietly.

However this is when social media can be useful because people see breastfeeding in public, have an immediate and visceral reaction and pick up their smartphones to express it, often imagining they are tweeting quietly to their friends.

The number of people who misunderstand that Twitter is not a private forum is rather sweet and for these purposes, quite useful.

And hats off to the breastfeeding supporters (such as @Wolf_Mommy) who trawl through Twitter and try and engage with some of these people. They are often young men and women in their late teens and early 20s:

@onyx918 I don't think there is anything normal about having any of my children sucking out anything that i put into my body.


@deonmcallister still can't get over that lady breast feeding in the library today, WHO IN THE RGHT MIND WOULD WHIP A TIT IN THE LIBRARY OF ALL PLACES!

@mariahurtado92 So I came to drink my shake and there this women breast feeding her child #ewww

@_MizJohnson Is this lady really breast feeding in our restaurant!!!!!!?????!?!?!?!?! @ the table too!!! That's what we have a bathroom for! #ClassLESS

There is a common view that a toilet is the place to feed an infant. But even women feeding their children here can’t win:

@booboo_92 This is why I hate public restrooms. I do not need to see you breast feeding your infant child!!! Ughh.

When these tweeters are challenged, they often talk about their preference for mothers to use formula or to cover up or for mothers to pump their milk and use a bottle.

The power and rise and development of the electric breast pump may have done us no favours in this arena. It removes the oral contact which for many is the area of discomfort. And in a society where campigns often revolve around the benefits of ‘breastmilk’ (see New York City currently), technology may not be our friend in this battle.

Our society is confused. While the couple is prioritised and sexuality is key, we also promote the desexualised view of motherhood. Can you be a ‘yummy mummy’? Yes, if you fulfill certain criteria. Can you be sexy WHILE you are breastfeeding? In that moment? Just as in Papua New Guinea and among the Gogo women of Tanzania, we are desexualised during breastfeeding. Women are supposed to be a functional part of a couple but they are expected to put their sexuality in a little box. They need to compartmentalize themselves. One minute they are the mother figure. When the baby is away from them, they are allowed to switch on the other type of ‘Madonna’. There are no Mother and Baby magazine articles on breastmilk and foreplay. There are no open discussions about breastfeeding and sex. One mother confided to me that she and her husband had on occasion been having sex while she was breastfeeding her infant. That concept would provoke a strong reaction for many. We need to think more about why? Would a mother even be ‘allowed’ to look lustfully at her partner while breastfeeding or use sexual language? That doesn’t follow the expectation of compartmentalization.

 Sometimes women who are not feeling sexual during motherhood are told to ‘grin and bear it’. This is a phrase actually used in the ‘The Contented Mother’s Guide’ by Gina Ford. And several mothers quoted in the guide talk about using wine to force themselves back in the saddle. Women are encouraged to switch off certain sides of themselves while at the same time feeling a pressure to meet society’s expectations of successful coupledom.

If you google ‘nursing bras’ and look at the images that appear, the image is of a lingerie model seductively opening her strap clasp with the wind machine in her hair and fully made-up. She’s still doing her sexy model thing. Would she be allowed to look like that if there was a baby sitting on her lap?

Look at the images using by pump manufacturers of women with pumps attached.  

http://www.amazon.com/Medela-67050-Swing-Breast-Pump/dp/B000I0TF9E

Scroll down to find the lady in beige. She’s gazing seductively at her Medela pump. If there was milk in that collection bottle, would she be allowed to look like that?

And while you are opening internet windows, remind yourself of the recent cover of Time magazine.

The woman who doesn’t put herself in a box and doesn’t compartmentalize, who is sexually ‘integrated’, pushes a lot of buttons. Imagine if this woman wasn’t staring out at us with that gaze, if she was wearing loose and unfashionable clothing, if her hair and face was different. What about if she was breastfeeding a baby but still looked like that and looked out at us like that?

As another tweeter @sassycrass says, “It’s not a woman’s nudity that upsets you. Nope. It’s her liquid movement from the realm of the sexual into the realm of the maternal and back, if and when she wants.”

If the compartments were broken, if bras and breastpads came off in the bedroom, if breastmilk and sex wasn’t icky, what would the power of woman be? What couldn’t she do?

Some ‘take home messages’:

1.       Breastfeeding affects sex but perhaps more significantly - our society’s thinking about sex affects breastfeeding. Things going on in bedrooms are affecting breastfeeding and it’s time to talk about it.

2.       Breastfeeding supporters may need to be some of those people having those conversations and we may need to start by reflecting on our own experiences of sexuality and breastfeeding.

3.       Antenatal education needs to be a time when honest conversations about sex can happen. Talk about the sexualisation of the breast. Look at advertising images. Have father-only chats. Talk about tasting breastmilk and fears and how we might be getting to 6 months happily.

4.       Discussions with our daughters (and sons) about photo-shopping and body image is not just about their self-esteem or whether they might end up wanting cosmetic surgery, it’s about making a future generation of breastfeeding women and father who support them.  A crucial element is how we talk about our own bodies in front of our children. We are role models. The charity ‘Media Smart’ has just launched a parent pack aimed at supporting parents in the conversations they have with their children about body image. You can download the pack here: http://www.mediasmart.org.uk/parents-pack.php

Appendix:

And while we’re talking about sex perhaps we should also talk about supporting breastfeeding women with contraception.

As breastfeeding supporters, we often feel that it’s important that breastfeeding women understand the value of L.A.M (Lactational Amenorrhea Method). If women are feeding a baby under 6 months and their periods have not returned and they are feeding regularly throughout a 24 hour period (at least every 4 hours in the day and every 5 hours at night), then breastfeeding alone is considered as a method of contraception of around 98% effectiveness.

Of course, if only 3% of women are exclusively breastfeeding by 5 months, these conditions may not be applying to a large volume of women.

And for many women who have spent a lifetime worrying about unwanted conception, there may be psychological barriers to trusting this method alone.

Most women understand that hormonal contraception containing oestrogen is regularly connected to a diminishing milk supply. Progesterone is also anecdotally connected to supply problems but it’s important to understand this is only anecdotal and provided a mother is 6 weeks post-partum, there isn’t evidence to suggest progesterone-based contraception is routinely a problem for breastfeeding women. If there is concern, a possibility is to trial a progesterone contraceptive pill and provided there are no issues, a different method such a the depo-provera injection or implant is a possibility. The Mirena coil delivers a localised dose of progesterone to the uterus and seems less of a concern in these anecdotal reports.

Emergency contraception is also available to breastfeeding women. The Levonelle emergency contraceptive pill is licensed for breastfeeding women and can be used up to 72 hours after sex. A copper IUD can also be inserted up to 5 days later.

For some women, the issue is not trying to avoid getting pregnant while breastfeeding but a strong desire to conceive again without ending a breastfeeding relationship.

This is likely to become even more of an issue as the average age of motherhood continues to increase. In the UK it was 28.5 yrs in 2000, 29.4 yrs in 2009 and 29.5yrs in 2010.

The Office for National Statistics states that from 1990 to 2010, the number of live births to mothers over 40 has trebled.

If you practice ‘ecological breastfeeding’ and follow all the Department of Health and World Health Organisation recommendations, the average time for the return of a woman’s periods is 14.6 months. Many women don’t feel that they have that long to wait.

If we are supporting a woman who wishes to fall pregnant, one message is that abrupt changes in breastfeeding patterns are more likely to provoke hormonal changes and cycle changes than gradual slow ones. But what else might it risk? Blocked ducts and mastitis? Or distress for a nursling? Mothers are having to make decisions that feel difficult.

The later a woman’s cycles return, the more likely that ovulation will occur before the first period. When periods return earlier, the early cycle is often infertile and a woman may not achieve luteal competence.

There is a massive range of normal. But I think it’s important to be honest as breastfeeding advocates and state that for some women, continuing to breastfeed may be compromising their fertility. There are those of us who fall pregnant easily while breastfeeding but we must not pretend this is going to be everyone’s story.

Some breastfeeding women are considering whether to undergo IVF or fertility treatment. Many clinics will ‘require’ women to stop breastfeeding. And some women will simply mislead clinics and claim they no longer breastfeed when they do. Some fertility drugs have not been studied sufficiently to ascertain their safety while breastfeeding. Clomid is commonly used but has also been used elsewhere to suppress lactation and has been connected to a reduction of serum prolactin.

Older women and women with a history of fertility problems are likely to be those mothers with a particular commitment to breastfeeding. The dilemma of whether to prioritize breastfeeding or conception  can be a painful and difficult one.

 

I’m still thinking about sex and breastfeeding. And it appears quite a few other people are, based on the search terms that lead people to my blog.

<Waving hello to the seeker of a ‘sexy lactating woman’ or the person looking for something on ‘breastfeeding woman sex>

As previously mentioned, I’m speaking on the subject at the Association of Breastfeeding Mothers conference in Birmingham in June. I’m reading survey data (580 respondents), reflecting on academic papers and examining photographs of Pamela Anderson.

<Waving hello to the person who finds this blog after searching ‘Pamela Anderson’>

Let’s reflect on Pamela Anderson* for a moment. Let’s picture her in 1995 jogging along a beach in an efficiently- measured red swimming costume. And let’s think about her breasts.

Admirable.

Look natural?

Yes, perhaps if you are a breastfeeding mother. Yes, because that’s what newly- engorged maternal breasts look like.

The cult of the augmented breast is all about that inflated engorged look. Picture it running in slow motion...

Men do the manly equivalent of swooning.

That same breast with a baby attached or a baby nearby or...

...a drip of milk hanging?

Still swooning?

Good God, no.

Because that would make you WEIRD, wouldn’t it? Surely?

One subtle difference – referring to the inherent purpose of the mammary gland, the one associated particularly to that shape of breast - and WHOAH, a switch is expected to be flicked and sex is disconnected.

The Western cultural view of the attractive woman is an ultra-thin woman with large breasts. We are in a mix-up. Maternal engorged breasts but ‘tight abs’ and a non-maternal torso. Young women must diet to achieve the torso shape, inevitably leading to a reduction in breast size, so augmentation surgery becomes the norm. An ‘A cup’ is seen as abnormal, even a ‘B cup’. There is a proliferation of young women starting their adult life by artificially increasing their breast size to fit our cultural ideals.

Kathy Dettwyler makes some points in her essay, “Beauty and the Breast: the cultural context of breastfeeding in the United States” that are shocking to us because we are so embedded in these assumptions, even those of us constantly reflecting on the world of breastfeeding, that we struggle to see the big picture.

Dettwyler asks us to think about the foot-binding tradition of China. The tradition that existed in China for a considerably length of time where the fetish of the tiny foot developed to an extreme and young women mutilated themselves to fit the ideals of men’s desire and sexual attraction.

She says:

“Just as it was inappropriate for people in Chinese society to let the cultural idea that deformed feet were sexually stimulating overshadow their primary biological function for walking…it is inappropriate to let the very Western cultural idea that breasts are for men, overshadow their primary biological function for feeding children”

[P.202 Breastfeeding: Biocultural perspectives. Ed. Patricia Stuart-Macadam, Katherine A. Dettwyler]

You may think, “Come on!” It’s hardly a Western cultural idea that breasts are fanciable. Men are hardly able to control their urges that come from biology and inherent attraction. Give the poor guys a break. It’s not ‘culture’ that has the Baywatch slow-motion run so admired.

You may think.  You may think, “Hey, it’s evolution. We’re attracted to the breasts that look like they’ll be good providers – or something”.

However, the concept that the female breast is attractive is very much a cultural one and remarkably unpopular when you get down to the anthropology.

Yes, really.

In 1952, Ford and Beach undertook a cross-cultural survey of 190 cultures from around the world.

In just 13 of those cultures, men found breasts sexually appealing.

9 liked large breasts. 2 liked long pendulous breasts. 2 liked upright, hemispherical breasts.

And by the way, evolution would tell you fairly sharpish that large augmented-type breasts don’t necessarily make the most effective long-term breastfeeding breasts anyway. Those long pendulous ones may well do the job far better.

Humans live in societies that find breasts sexy and they LEARN to find breasts sexy.

This isn’t bad. This isn’t wrong. But it’s where we are.

It would make life a lot easier if we somehow managed to combine this reality with the notion that the primary purpose of the mammary gland is feeding young. If we could JUST find a way to value both of those things simultaneously, life would be a lot easier.

But we struggle. New mothers are struggling to work out how to incorporate their breasts into their sex lives. New fathers are not quite sure how to process some confusing feelings and whether they are allowed to talk about some of these confusing feelings. ARE we allowed to be turned on by dripping breasts? Are we allowed to find our wives feeding erotic? Is my mouth still allowed to touch this breast?

These are not conversations for the NCT dads’ night out in the pub.

So we forge on alone.

And there are huge repercussions for the wider view of breastfeeding in society. Dettwyler is particularly talking about American society but it’s applicable to the UK. She talks about how if breasts are primarily fulfilling their cultural purpose to be sexually attractive, then a woman breastfeeding must shun that view for a while (as long as she can bear) in order to fulfil her biological purpose.

Of course, feeding in public becomes a very different concept in the society of the highly sexualised breast. That means that women also are much less likely to see breastfeeding around them and girls grow up without ever having seen breastfeeding first hand.

HOW much TIME do those of us who support breastfeeding mothers spend talking about positioning and attachment?

And how many of those conversations might be redundant in a world where, when we finally come to breastfeed and hold our own child, our brain is full of images dating back decades?

And if breasts are sexual and breastfeeding is private and part of our ‘private world’, when a mother wants to bring breastfeeding into the workplace she’s sometimes up against it. Not least because breastfeeding is supposed to be short-lived, surely? What’s she doing still wanting to pump after 6 months or even a year?

We live in a society where the extended family is often Skype- based at best. The couple at the centre of the nuclear family is exalted. Our partners are expected to fill a huge space in our lives and we also live in a highly sexualised society.

And if we’re in a bit of a tizzy about how a lactating breast fits into our sex lives and how a lactating mother continues as a sexual person, is it so surprising that the rates of mothers still exclusively breastfeeding at 6 months is so underwhelming? I’m not saying exclusive breastfeeding rates at 6 months is hardly measurable because people just fancy a shag, but I am suggesting that our cultural attitudes towards the breast has a part to play.

Dettwyler was writing in the mid-1990s.

I think if she was writing today she may take a moment to also consider breastfeeding rates among young women. If you were born in the mid to late 90s and you are a teenage mum today, what imagery of the breast have you lived with your entire life? How much more explicit is the world of the music video? How many bare breasts are used in advertising? How many celebrity mums are ‘bouncing back’ into shape? That CAR ADVERT on TV this week has the cartoon jiggling lass with the impressive cleavage.

They have been bombarded their entire lives. And they get pregnant and we expect them to switch ALL that off instantaneously and embrace a concept that they may never have SEEN or thought about before that leaflet gets thrust into their hand. This isn’t just about whether their mothers might have breastfed. This is about the fact that they are surrounded by models of the normal breast as the one designed for sexual attraction. Constantly. We expect them and their partners to just switch all that off.

Spend 10 minutes on Twitter and search for the term ‘breastfeeding’. You’ll find the supporters and lactation consultants. And you’ll also find some very very confused teenagers and young people who are occasionally encountering women breastfeeding out of the home and they literally don’t know what to do themselves. They pick up their smartphones (which they imagine are entering them into a private dialogue with just a few friends) and express this confusion.

So what next?

Anyone educating young people about breastfeeding or working with teenage pregnant mums should explicitly talk about this culture. Watch the music videos. Look at the advertising. Talk about what’s been going on and where their feelings come from and acknowledge breastfeeding might not yet feel ‘normal’ and then try and explain why in fact it is.

And let’s talk to any new parent about breastfeeding and sex. Let’s not simply leave that to the lactation fetishists.

<Waving hello to the lactation fetishists>

A breastfeeding woman can be sexy without needing to go to bed wearing an industrial bra and breast pads and a desperate fear milk might APPEAR. I’m not expecting ‘Mother and Baby’ magazine to discuss how lactating breasts can be a normal part of foreplay but if an article like that was possible, I wonder how women might think about their bodies differently? Could there be a world where women can be both sexy and breastfeeding simultaneously without compartmentalizing themselves into the polarities of ‘Madonna’ or ‘Wife on a mini-break leaving the baby with the mother-in-law’? And if that integration happens, might more women and their partners imagine happily breastfeeding for longer?

I don’t know. But if we can find a way to find breasts sexy without losing touch of what their biological purpose is, it would be a brave new world.



*And the rather fabulous Pamela Anderson breastfed successfully with her implants. This isn’t about implants being incompatible with breastfeeding. It is about WHY implants are happening in the first place and what this tells us about how our society views the breast.