Body confidence and breastfeeding: it's up to us to join the dots

You are the most advanced human there has ever been. Thousands and thousands of generations have been preparing for your existence. Millions of years of births and deaths, predators catching prey, creatures mating at the exact right moment, an immense overcoming of unimaginable obstacles and here you are. It’s all led up to you.

Our ancestors would be blown away by our skills and our potential. And they’d probably want to throw something at us (hopefully not a hunting spear) when they realise how many of us spend so much time focusing on what we CAN’T do and our imperfections.

If they had been us, they would have been challenging others as the next leader of the tribe. Instead, we’re often wondering if our thighs are the right shape.

Or when the time comes to be a parent, do our breasts work as they should?

Breastfeeding struggles in our society for a dozen different reasons including lack of investment and gaps in health professional training.

It’s important to recognise that our attitudes to our own bodies are part of the problem.

Online surveys were conducted by the Mental Health Foundation with YouGov in March 2019 of 4,505 UK adults 18+ and 1,118 GB teenagers (aged 13-19). One in five adults (20%) felt shame, about one third (34%) felt down or low, and 19% felt disgusted because of their body image in the last year.

Among teenagers, 37% felt upset, and 31% felt ashamed in relation to their body image.
Just over one in five adults (22%) and 40% of teenagers said images on social media caused them to worry about their body image.

One survey of 11–16-year-olds in the UK by ‘Be Real’ found that 79% said how they look is important to them, and over half (52%) often worry about how they look. In a survey of young people aged 13–19, 35% said their body image causes them to ‘often’ or ‘always’ worry. 

When we believe our bodies are deficient on the outside, it’s not a stretch for us to feel they are also deficient on the inside? If we feel we are not enough, that is inevitably going to make breastfeeding a challenge.

As breastfeeding supporters are often parents ourselves, we are in a key position to shape how the next generation feel about their bodies and their breasts.

It can be easy to imagine that we are at an advantage because our children overhear the phone conversations and are with us when new parents stop us in the street and talk about nipples. They live in houses surrounded by books about breastfeeding and the normal function of breasts.

But in some ways, we may have to work harder.

​Our home may not represent the messages they will receive from the wider world. Can our pre-teens and teenagers come to us when they feel uncomfortable about breasts, don’t trust them, don’t like them, want to hide them? Our society sends contradictory messages about why breasts matter and it can be confusing.

These feelings do not magically disappear in young women once a positive pregnancy test is in their hands. The grinding pressure that your body is not ‘good enough’ does not disappear as the months go by. Nor do they disappear once breastfeeding begins.

As breastfeeding supporters, we have a duty to join the dots. Can it really be a coincidence that we struggle to maintain breastfeeding and trust breastfeeding when we struggle so much to have faith in our bodies overall?

In Sikhism, the human body is a gift from the divine spirit. When you war against your body – by believing you are deficient and need to change - you are in conflict against God but also in conflict against your own spirit. Even for anyone who isn’t religious, there is a spark of truth there. There’s a lack of peace that comes from feeling you are never enough – just one more pound lost, one more week in the gym, a wish that your facial features were someone else’s.

Of course, it’s not easy to find that peace. We live in a society where many people devote many hours to trying to unsettle us. It is someone’s job (a LOT of people’s jobs) to try and make you feel deficient. Something your ancestor with the spear did not have to worry about – he had different sabre-toothed tigers. Yours work for advertising agencies and large multi-national companies. They sponsor social media posts and pay celebrities to use their products. They hire models. They persuade supermarkets designers to put products in your face. You aren’t an individual to them but part of a sea of bank accounts and cash. They may not even be consciously aware they are one of the bad guys. They have absorbed this culture too and for them, this constant poking is part of normal. When they were younger, it was magazines and billboards that told them they weren’t ‘enough’.

Not all fashion models might be skinny and tall these days, but they are still conventionally pretty. If they are women, their breasts are symmetrical and round (which is often not the case in real life).
It’s interesting how the movement towards a wider representation of body image seems to have bypassed breast diversity. More than 50% of young people experience breast asymmetry as their bodies change and asymmetry remains very common in adulthood. When have we ever seen asymmetrical breasts on a photo, in a film, on television?

What are often called ‘saggy’ breasts are also a variant of normal breast shape. But our culture represents them as either something to do being an old crone or falsely, something to do with breastfeeding. In fact, sagginess is about a lot of things: pregnancy, smoking, weight loss. It’s true that as oestrogen is lost in menopause, connective tissue becomes dehydrated and breast shape can change. But young women can have breasts like that too. Look for the beautiful and brilliant Chidera Eggerue. Her description of trying to buy a bra as a teenager and finding every option available telling her that her body was abnormal is heart-breaking. Not all teenagers would come through that experience as she has.

Some will turn to surgery. Women still make up 92% of cosmetic surgery procedures in the UK. In the British Association of Aesthetic Plastic Surgeons’ 2019 annual audit, of the 26,043 procedures done on women, 11,741 were breast related.

We are finding that even today, surgeons are not telling the full story when it comes to the impact of breast surgery on future breastfeeding choice. A leaflet on breast reduction provided by a major professional surgical association contains one reference to breastfeeding and says, “Rarely, reduced sensation can cause problems with breastfeeding.”

In fact, those of us who support breastfeeding parents post-surgery know that when a nipple has been entirely removed and the intercostal nerves needed for a working milk ejection reflex have been severed, the complications can be significant. There are too many IBCLCs supporting new parents who were told, “breastfeeding shouldn’t be affected” by their surgeons. It can be possible to breastfeed and even exclusively breastfeed after surgery, but it often takes a great effort and the reality is not being shared. Perhaps not through intentional deceit, but by health professionals who lack an understanding of breast anatomy through their own training. If you are told women usually have 20-25 milk ducts (rather than an average of 9), you are likely to make different surgical choices.

We often say when we support new parents and babies that ‘there’s a lot of normal’. That is true of breasts specifically. How often do we talk to the mother who is worried because one breast has a pumping output of X mls and the other only Y? We reassure by saying that we are all a bit asymmetrical and it’s normal to have different pumping output. Wouldn’t it be amazing if she already knew that, because everyone expected breast asymmetry? Instead, she often feels like she has to fix herself.

Women often feel like they are supposed to be fixing themselves. Some of us will have supported mothers who apologise for their body shape. A breast that hangs low with a nipple pointing towards a mother’s lap is not the breast you will often see in the antenatal class handout. We meet them often. These mothers may feel they have to hold and move their breast to fit some sort of ideal: so they can use the breastfeeding pillow they are ‘supposed to’ or so they can do the ‘tummy to mummy’. In reality, their ideal breastfeeding position may involve a baby facing the ceiling and ‘tummy to mummy’ just means a baby having to twist its head uncomfortably.

As breastfeeding supporters, we need to bring the solutions to the mother and her body and her baby’s body. We look for the ‘angle of the dangle’. We don’t try and twist (nor literally twist) the mother to fit what breastfeeding should look like.

We may meet new parents with accessory breast tissue. When 1 in 18 (around 6%) have accessory breast tissue, that won’t take long. It’s rarely talked about. Chandler from Friends has a nubbin and that’s pretty much all most of us know.

Some of us will have accessory breast tissue but perhaps not be aware we have. It may only be in lactation, when that the mole on your tummy starts to do surprising things. You may be used to armpit tenderness during your menstrual cycle, but you are taken by surprise when you experience post-partum engorgement there. It can be frightening when everything you read, at one of the most vulnerable times in your life, tells you that you must resolve this ‘blocked duct’ or you will end up with mastitis. It might be that time and cold compresses are all you really need.

I attended an event in August led by doula Ruth Dennison (@121doula). It was focused on Black Breastfeeding Week and one of the speakers, Nehanda Truscott Reid (@soulamamajourney), led us through a breastfeeding mindfulness session which was powerful even though few of us were breastfeeding. Ruth also shared some breastfeeding affirmations with us. It’s easy to dismiss such techniques as ‘hippy’ or ‘cheesy’ but this is missing the point. It can do no harm to focus on positive messages. All day, and in the years prior to motherhood, we absorb the negative. We are told our bodies are deficient on the outside by powerful forces. Why would we not begin to feel we are deficient on the inside too? When we repeat positive messages and visualise positive messages, that can only be a good thing. We’re just not all used to doing it.

Of course, lactation cookies, taking handfuls of capsules and buying the most expensive pump feel necessary when you believe you are hard-wired to not be enough. When a baby seems unsettled, we’re going to doubt our own body first. Every time we pick up our phones are deficiencies are illuminated. So we need to shine a different light.

As breastfeeding supporters, we not just providing practical information and signposting and solving the nipple problems. We are helping new parents to see themselves in a different way.

We need to put young people in touch with the Chidera Eggerues and the Jameela Jamils. Having conversations about Instagram influencers and Snapchat filters and advertising imagery isn’t just about creating happy teenagers. It’s creating happy 50-year-olds. We need to join all the dots between celebrating body diversity and our ability to be successful human beings and that includes successfully breastfeeding human beings.