Why is breastfeeding so bloody hard?!

This post by Growing Families organiser Elena Abell was originally shared on her personal blog platform, Trust Your Baby.  Elena works as a Business Unit Director for healthcare communications company Watermeadow Medical in Witney, Oxfordshire. Her background is molecular biology having studied to PhD level at Imperial College London, and she is also a qualified babywearing consultant.  You can find out more about Elena and the other three members of our conference team here: https://growingfamilies.co.uk/conference-team/

We are incredibly fortunate to have Emma Pickett IBCLC leading our breakout session on breastfeeding in October – sign up for this session to find out how to give yourself the best chance of meeting your breastfeeding goals, whatever those might be.  Expecting a baby? New to parenting or wanting to explore more about what you know? About to become a grandparent? Supporting new families?  Then this conference is for you!

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At 2 ½ weeks into breastfeeding my newborn son, I was ready to jack it in. I developed an excruciatingly painful cracked nipple (think toe-curling, eye-watering pain!), and I dreaded every single feed. Not exactly the easy, picture-perfect breastfeeding experience I had imagined. Far from it….It was a very dark time and I felt like an utter failure for considering giving up. I’m happy to say I managed to persevere through sheer bloody mindedness and some fabulous peer support but since then, it has really bugged me…

Why is something that is supposed to be so ‘natural’ so bloomin’ difficult?

Well….as it turns out, we really shouldn’t be blaming ourselves, AND it’s not just humans that find nursing their newborns difficult…..all the great ape species do. Here’s a little story for you….In 2012, at North Carolina Zoo in the USA(1), a captive born and raised chimpanzee called Maki gave birth to her first baby. Baby Nori was the first baby chimp to have been born at the zoo in 12 years but it soon became apparent that Maki wasn’t able to nurse her baby effectively. Eventually, baby Nori had to be taken away and hand-reared. Spare a thought for poor mama Maki though; in her short, captive life, she had never even seen a baby chimp before, let alone observed any other chimp mamas nursing their offspring. No wonder she found nursing difficult. She had absolutely no idea what she was doing. Research shows us that primates (yep, that includes us) who have never observed or experienced nursing  face a strong likelihood of failing to nurse successfully.(2,3)

By comparison, for ‘lower’ mammals such as cats, dogs, horses and cows, nursing is instinctual (meaning it’s not a learnt skill, it just comes naturally) and they make it look easy. The offspring of lower mammals are relatively well developed and mobile at birth and their babies are able to root, find a nipple and latch with pretty much no help from mum at all. Primates however are an exception to the rule of easy nursing.(4) Most primates require a period of learning in order to successfully nurse their babies,(5) and for humans at least, this may be the price we have paid for having evolved a relatively large and flexible brain that is capable of learning lots of new skills. In fact, the greater the intelligence of a primate, the greater the need for learning, and as it turns out, humans may be the most problematic nursers of all primates, if not all mammals.(4)

Interestingly, primate researchers have found that for apes living in captivity, being reared by an ape mother and observing other ape mothers means that new ape mums are more likely to successfully nurse and raise an ape infant.(6) In fact, there is evidence that specific training programs aimed at teaching maternal skills to apes can significantly improve their ability to appropriately care for and nurse their infants.(7) Sounds scarily like NCT courses for apes! But seriously, we’re no different to our ape cousins and almost certainly, like most other primate females, human mothers do not have an instinctual knowledge of how to feed their baby, meaning we need appropriate support in order to ‘learn’ to breastfeed.(4) In fact, research shows that on balance it’s TWICE as challenging for humans to learn to breastfeed properly as it is for other great apes.(6,4) How very unfair! Basically, there is a perfect storm of factors that make it spectacularly difficult for humans to breastfeed.(4)

  • Human intelligence: it may be that humans face an extra disadvantage when it comes to breastfeeding, because of our heightened intelligence. Having a larger brain that is ultimately more flexible, and more capable of learning than other apes, may result in an increased reliance on learned behaviours over instinctual behaviours.(4) It seems that humans and other primates ‘lost’ the ability to breastfeed by instinct very early on in our evolutionary history.(4)
  • Human breast shape: This is a classic case of form over function. We all know that human males love boobs, right? In our evolutionary history, men would have been more attracted to women with the most prominent boobs as this would have signaled fertility and health.(8) Because we use our boobs as sexual ‘signals’,(9,10) our boobs are now more rounded compared with our flat-chested primate cousins. However, this rounded shape means that human infants rely on a more complex set of mouth movements to retrieve milk from a human breast than other primates and mammals.(4,11-13) Although this complex sucking action in human babies is instinctual for them, they generally require assistance from the mother in order to successfully translate that reflex into successful breastfeeding.(14)
  • Infant development and mobility at birth: Humans evolved to walk on two legs but this means we have a relatively narrow pelvis and birth canal. As such, human babies need to be born relatively underdeveloped so that the brain and head are still small enough to pass through the birth canal. All this means that human babies are much more helpless at birth than other primate babies and it’s almost impossible for human babies to breastfeed without some assistance from mum. For example, without help from mum, newborn human babies find it very challenging, at least at first, to insert the nipple far enough back into their mouth to avoid seriously stressing out mum’s nipple and making it sore.(4,15) That means that if our technique is even a bit wrong, we’ll have very sore nipples, something very many of us mums have experienced I have no doubt. A helpless baby also means smaller, weaker jaws, which, as mentioned above are trying to carry out these more complex sucking movements than our primate cousins,(4) so it’s no wonder that we, as human mums find breastfeeding tricky.

Breastfeeding was crucial to the survival of our ancestors, yet it’s clear that humans face potentially significant challenges associated with breastfeeding. This is an evolutionary dilemma – breastfeeding is essential for survival, yet it requires (potentially variable or absent) learning and support.(4) Our human ancestors found the perfect solution to this problem however. We evolved to live in large, stable and supportive groups meaning that baby care could be shared among not only the parents, but extended family and other members of the group.(4) You might have heard the traditional African proverb ‘it takes a village to raise a child’? How very, very true this is.

It takes a villageSimilar to other primates, this predictable, group environment allowed human women to observe and learn the techniques of breastfeeding from other women. Evidence for this ancestral ‘group’ approach to breastfeeding comes from traditional cultures, where breastfeeding is the norm and women are frequently exposed to it.(4) In these cultures breastfeeding initiation rates are almost 100%, and after 6 months, breastfeeding rates of 98% are still seen.(4,16,17) Compare this to a woeful 74% initiation rate in the UK, which falls to 47% after only 6-8 weeks.(18)

Our ancestral history suggests that the support and instruction provided by breast feeding ‘peer supporters’ and the experience of family and friends may be a crucial part of any new Mum’s plan to successfully breastfeed.(4) Modern and international pro-breastfeeding organizations such as La Leche League (who teach and promote breastfeeding techniques), hospitals and midwives are playing an increasing role in reviving this ‘group’ breastfeeding culture. However, all too often I think new mums expect that they should just instinctively know how to nurse, and be able to just ‘get on with it’. If new mums are not adequately prepared, or set up with help and support from the beginning, they can end up feeling like utter failures, if or rather when they encounter problems. It shouldn’t be like this. The onus should be on society as a whole to create that ‘ancestral’ group support that helps teach and encourage new mums to breastfeed successfully. For those of us who are or have been nursing mothers, it’s also super important that we share our experiences with other women who are just beginning their breastfeeding journeys. Like our human ancestors and primate cousins, we ALL need support and encouragement to learn how to breastfeed.

If you’re a mum-to-be or new mum (or know someone who is!), here’s my 5 point plan to help prepare for the ancient art of breastfeeding.

5 point plan__1024

Elena Abell
June 2016 (first published October 2014)

1. http://www.zooborns.com/zooborns/2010/08/baby-chimp-doing-well-at-nc-zoo.html. Accessed 21/09/2014.
2. Abello, M; Fernandez J. International Zoo Yearbook, 2003; 38: 186-191.
3. Harlow, H;  Harlow, M. Bulletin of the Menninger Clinic, 1962. 26: 213-224.
4. Volk, A. Journal of Social, Evolutionary, and Cultural Psychology, 2009; 3(4):305-314.
5. Smith, H. Parenting for Primates, 2005. Cambridge, MA: Harvard University Press.
6. Abello,, M; Colell, M. International Zoo Yearbook, 2006;40:323-340.
7. Desmonde, T; Laule, G; Zoo Biology, 1994;13:471-477.
8. Møller, A. Ethology and Sociobiology, 1995;16:207-219.
9. Barber, N. Ethology and Sociobiology, 1995;16:395-424.
10. Morris, D. The naked ape: A zoologist’s study of the human animal, 1969. Toronto: Bantam.
11. German, R; Crompton, A. Brain, Behavior, and Evolution, 1996;48,:157-164.
12. German, et al., Journal of Experimental Zoology, 1992;261:322-330.
13. Woolridge, M. Midwifery, 1986;2:164-171.
14. Fisher, C.  Journal of Maternal & Child Health, 1981;6:52-57.
15. Righard, L; Alade, M. Birth, 1992;19:185-189.
16. Houston, M. Journal of Advanced Nursing, 1981;6:447-454.
17. Lee, R. B. The !Kung San: Men, women and work in a foraging society. 1979. Cambridge, UK: Cambridge University Press.
18. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/206553/Breastfeeding_Statistics_2012-13.pdf. Accessed 21/09/2014.

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