Ina May's Guide to Breastfeeding
How Breastfeeding Works, and How It Relates to Mothering
We women are all born with the right equipment for breastfeeding. Big breasts, tiny breasts, long nipples, flat nipples, light nipples, and dark nipples all work very well for milk-making and breastfeeding. The basic milk-producing equipment is present in all the variations that we see in the human female. Why, then, is it so much easier for some women to breastfeed than it is for others? This chapter is intended to give you a foundation for understanding why this is so. There are external factors that can interfere with your innate ability to nurse your baby, but the important thing for you to remember is that these have nothing to do with the body you are dealt at birth, which has the capacity to work right.
Breasts are amazing, complex organs, which are able to produce, secrete, and deliver the most perfect food possible to your baby, who is hardwired to take it in. Your breasts are even talented enough to adjust the composition of your milk according to the gestational age of your baby at birth and to the amount of heat and humidity in your environment at any given moment.
Let’s take a quick look now at the different kinds of tissues that make up your breasts. First there is the glandular tissue of your breasts, the network of grapelike clusters (alveoli) and ducts that make the milk and move it along. Next, your breasts contain a web of ligaments that help to support their weight. Then there are the nerves of the breast and nipple, which make them sensitive to touch. It is this network of nerves that responds to your baby’s nuzzling, suckling, head-bobbing, and caressing, by sending the message to your pituitary gland to secrete pro-lactin, the hormone that signals your breasts to make milk. You’ll probably learn later on that your baby’s cry and even the thought of your baby can do the same thing. The rest of your breast tissues are the more-liquid components: the blood, which nourishes all the rest of the tissues and provides the nutrients needed to make milk, and the lymph, which removes wastes.
By the way, none of the tissues mentioned so far has anything to do with the size of your breasts. Breast size depends upon the amount of fatty tissue in your breasts, not upon the amount of glandular (milk-making) tissue. Some of us have a lot of fat in our breasts, while others have more-moderate amounts or very little. The amount of fat has no effect on our ability to make milk. Pregnancy means dramatic breast growth in some women, but women who still have tiny breasts at the end of pregnancy are quite able to fully breastfeed their babies.
Your nipple sticks out from your areola; it is in the middle of the darker-colored part of your breast. Both nipple and areola contain erectile muscle tissue. When your nipple is stimulated by touch, cold, or a visual or auditory cue, these muscles contract, and your nipple becomes hard and erect. Once your baby takes it into her mouth properly, it will take on an entirely different shape, doubling in length and conforming to the shape of your baby’s mouth cavity.
Hormones That Affect Lactation and How to Elicit Them
It takes more than the right “equipment” to make milk—it is also necessary for that equipment to get the signal that it is time to start producing and releasing the milk. This is the job of certain hormones that are produced in the body, hormones that may rise or fall according to the mother’s stress level and the atmosphere in which she first starts suckling her baby.
The hormone oxytocin plays as large a role in lactation and mothering as it does in the process of labor and birth. When you feel your uterus contract during or after labor, you are feeling just one of the many effects of oxytocin: in this case, the ability to expel something from a bodily organ. Oxytocin not only stimulates the muscles of the uterus to expel the baby at the culmination of labor, it also stimulates the muscles of the breast to expel milk during nursing in what is called the “letdown reflex.”
Oxytocin has been called the “hormone of calm, love, and healing” because of the kinds of feelings it causes in the mother and the interactions with her baby that often trigger its release.1 For instance, it has been found that a newborn baby can cause additional oxytocin release in the mother’s bloodstream by massaging, nuzzling, or licking her nipple. Both skin-to-skin contact and eye-to-eye communication between mother and baby also trigger the release of oxytocin. Under the influence of high oxytocin levels, mother and baby tend to stare at each other lovingly, provided that skin-to-skin contact—or only light clothing between them—is the norm just after birth and there are no distractions or interruptions.
Mom and baby under the influence of oxytocin
Extremely high levels of oxytocin persist in the bloodstreams of mother and baby for about an hour after vaginal birth, giving both a feeling of well-being and gratitude. Higher levels than usual will persist throughout the nursing period, as long as the mother doesn’t have extremely high levels of stress (since high levels of stress hormones inhibit the secretion of oxytocin).
And though severe stress can sometimes inhibit the release of oxytocin, research has also shown that oxytocin often lowers stress in lactating women by slowing the heart rate and reducing blood pressure. There is evidence that the powerful calming effect that breastfeeding can have on a mother during the early weeks of life is long-lasting: Dr. Kerstin Uvnäs Moberg, a Swedish oxytocin researcher, found that women who breastfed their babies for the first seven weeks were calmer when their babies were six months old than women who never breastfed. Her research team also found that small amounts of oxytocin reduce anxiety and increase curiosity and a willingness to relate with another being. In Moberg’s words, “Oxytocin is physiology’s ‘forget-me-not’ that makes recognition and bonding reverberate in the nerves’ pathways.” Larger amounts of oxytocin, such as that which a mother and baby might experience during a longer nursing session, produce a more pronounced calming effect—a tendency to move around less, to relax and rest. The same research team discovered that oxytocin also alleviates pain. When a rat is given repeated oxytocin injections, it will take longer than usual to pull its tail out of water that is too hot. Oxytocin’s ability to reduce pain applies to both mother and baby and is a blessing that is quite noticeable when a breastfed baby must undergo a painful medical test or a new mother is healing after a cesarean.2
Are you surprised that one hormone can do so many different things related to nurturing and parenting? Actually, it can do all that and more. To illustrate what I mean, it is worth knowing that we women have the ability to produce oxytocin even when we aren’t pregnant. (Men can produce it, too, but its effects are more pronounced in females.) Oxytocin levels in the body rise when we enjoy a good meal (when we take the time to focus on it), whether alone or in the company of people we enjoy. It is no accident that business people consummate so many deals around a shared meal, as eating together causes oxytocin levels to rise, thus instilling a sense of calm and trust that makes it easier for people to cooperate with one another.
Another stimulus to oxytocin release in both sexes is pleasant, rhythmic touch. Much research has confirmed that oxytocin levels rise when we receive a hug from someone we care for or a soothing massage, as well as during meditation, a warm bath, or sexual arousal. As oxytocin levels rise, blood pressure drops, heart rate slows, and the digestive system functions at maximum efficiency. The same goes for healing: Our bodies heal better when oxytocin levels are high and our stress hormones are at a low ebb. When we are under the influence of oxytocin, problems that may have been bothering us previously tend to move into the background, and we may view our situation in a more positive way. We may also feel an enhanced sense of closeness to others and an impulse to greater generosity.
Consider the experience of Jiang Xiaojuan, the twenty-nine-year-old Chinese policewoman who was called a national hero by the media after the Jiangyou earthquake of May 2008. Officer Xiaojuan nursed nine babies whose mothers were injured or killed in the earthquake. For Officer Xiaojuan, whose own son was six months old, it was a simple matter. “I am breastfeeding,” she said, “so I can feed babies. I didn’t think of it much. It is a mother’s reaction and a basic duty as a police officer to help.”
While she was bemused about the media fuss over her actions, she did allow that she felt something special for these little ones: “I feel about these kids I fed just like my own. I have a special feeling for them. They are babies in a disaster.” I’m sure that this policewoman’s actions were prompted not only by a sense of duty but also by the increased level of oxytocin that she experienced when she encountered the hungry babies. Her milk flowed in greater quantities than usual because she felt a need to feed these helpless little ones.
All mammals share the ability to produce oxytocin, and expressions of maternal kindness and generosity are not limited to our own species. The Sriracha Zoo near Bangkok, Thailand, has attracted a lot of media attention in recent years for its cross-species suckling arrangements. Zookeepers there apparently do a certain amount of intentional “baby-snatching,” which is then followed by successful foster relationships that zoo visitors find entertaining. From this, we get the improbable sight of a sow suckling tiger cubs or of a six-year-old royal bengal tigress (who was suckled by a pig for her first four months of life) suckling six piglets and behaving as any loving, protective mother would toward her charges. Clearly, the zookeepers rely on the power of oxytocin to pull off such stunts.
Oxytocin-induced relationship of nurturing and trust
Who wouldn’t want to have high oxytocin levels during pregnancy and birth? This is best accomplished by having as much contact with your baby as possible right after birth. As mentioned, skin-to-skin contact is best, but even with clothes on and your baby wrapped in a receiving blanket, your oxytocin levels can be enhanced by just holding and caressing her. If you have had a stressful birth, holding and cuddling your baby will usually improve the way you feel almost instantly. One of the few exceptions to this would be if you feel so weak following birth that you are on the point of fainting. Common sense, of course, should rule in these matters. The amount of contact you have with your baby just after birth may vary according to whether you gave birth vaginally and whether your perineum needs stitching. However, women who have cesareans or need perineal repair will also benefit by both seeing and touching their babies as much as possible in the moments soon after birth.
More generally, the way to have a high level of oxytocin after birth is to avoid stress. Here I’m not referring to the work or even the pain of birth. Rather, this means any factor—including the people assisting your birth—that interferes with your ability to connect with your baby once her breathing is spontaneous and unassisted. This is especially important during your child’s first hour of life—a period of extraordinary sensitivity for both you and your baby, when your respective systems are meant to be in attunement.
Beta-endorphin is another hormone that has an important function around the time of birth and breastfeeding. From ancient times, humans have known about opiates (drugs derived from the opium poppy) and their ability to kill pain and produce ecstatic states of consciousness. However, it wasn’t until the mid-1970s that researchers discovered that the human body produces its own opiate: beta-endorphin. It is secreted by the pituitary gland and the hypothalamus in circumstances of stress, muscular effort, excitement, orgasm, and pain. Its properties are similar to those of morphine, heroin, and meperidine (Demerol), a painkiller commonly used in maternity wards in the United States, and it works on the same receptors of the brain. Anyone who follows sports closely is aware of the phenomenon that occurs when an athlete is injured on the playing field but is able to continue playing without feeling much pain. High levels of beta-endorphin are very effective at blocking pain receptors.
Beta-endorphin has another function: It facilitates the release of the hormone prolactin during labor, which prepares the mother’s body for lactation and helps the baby’s lungs finish their maturation process. Beta-endorphin is present in high levels for about three days following birth and then returns to its former level. However, it remains present in breast milk, which helps to account for the blissful expression we see on the faces of babies who have just enjoyed a good session at the breast.
Breastfed newborn just after feeding
Now we come to prolactin, which has been called the “mothering” or “nesting” hormone. Pro lactin, incidentally, means for milk in Latin. It is released by the pituitary gland during pregnancy and lactation and prepares the pregnant woman’s breasts for lactation by causing the maturation and proliferation of the mammary ducts and alveoli. High levels of the hormone progesterone inhibit the production of milk during pregnancy (though, in many women, not to the point of suppressing lactation if they are still nursing an older child). Progesterone and estrogen levels drop abruptly after birth, and prolactin causes the milk-producing cells in the mother’s breasts to begin producing first colostrum and then milk.
Prolactin is related to other forms of mothering behavior as well. It has to do with nest building, grooming, and comforting. Michel Odent has written that while oxytocin creates a need to love, prolactin creates a tendency “to direct the effects of the love hormone toward babies.”3Prolactin is likely to be the hormone that urges the mother to put her baby’s needs first and foremost.
Other effects of prolactin include stimulating the secretion of oxytocin and natural painkillers such as beta-endorphin, and the suppression of fertility. Like oxytocin, prolactin also helps reduce stress—for both mother and baby.
Interestingly, men and women have similar prolactin levels when there is no pregnancy.4 Studies have shown that fathers-to-be have increased prolactin levels, paralleling the increased levels of their partners. Holding babies appears to raise prolactin levels in men as well as women, and new fathers’ prolactin levels also increase when they hear their babies’ cries.5–6 New fathers with high prolactin levels tend to be more responsive to their newborns’ cries.
To sum up this discussion about the hormones that facilitate lactation, ease of breastfeeding is directly related to having high levels of oxytocin, beta-endorphin, and prolactin in the bloodstream around the time of birth. Nature endows each woman with the equipment to produce these hormones, but in stressful environments it can become more difficult for her to secrete them in the necessary amounts. This will be discussed later on in the chapter.
Baby’s first drink, colostrum, is the thick yellowish milk that your breasts begin to produce—usually, but not always, in small amounts—during the last half of your pregnancy and for the first two or three days after birth. Colostrum is protein-packed. It gives way to what usually seems like more than enough milk in a day or two (sometimes three or four) after giving birth.
Do not worry about whether you can produce colostrum. Barring some sort of serious injury or radical surgery, it would be impossible for you not to.
Colostrum is full of antibodies, immune factors, enzymes, and other goodies that help to get your baby started well in life outside your body. Partly a laxative, it helps your baby expel the dark meconium, which is your baby’s first poop. This action gets your baby’s digestive system ready to receive the greater quantities of milk that will soon begin to fill your breasts.
Exclusive suckling from the mother (that is, no supplemental feeds or drinks of other kinds) works best for human babies. Most exclusively breastfed babies who have unlimited access to their mother’s breast will drink only about an ounce during the first twenty-four hours after being born. That’s about two tablespoons, or one-eighth of a cup. If you are not used to U.S. cooking measurements, the amount is less than what would fill an egg cup.
Colostrum’s function is, in a way, more medicinal than nutritive. It is so important to newborn babies that even the mother who plans to bottle-feed her baby on an artificial milk would be well advised to give her baby only the colostrum from her breast for at least the first three days of life. Dr. Ruth Lawrence’s research has shown significant correlations between increased asthma, urinary-tract and respiratory infections, gastrointestinal disease, later obesity, and juvenile-onset insulin-dependent diabetes when artificial formula is given to babies soon after birth.7 When your baby swallows several mouthfuls of colostrum while nursing during the first two days, this small amount will maintain her blood sugar at the ideal level. It’s good to remember that your newborn baby is still making the transition from being fed by the placenta to actively feeding at your breast, at the same time that your body is making the transition from pregnancy (storing food in your baby’s vital organs) to lactation (producing food for your baby).
My friend who grew up on a farm, where her family raised sheep, told me that sometimes a ewe would give birth to the first of twins, and the firstborn would be too weak to get to its feet to reach its mother’s teat. My friend learned to milk a small amount of colostrum into her palm and drip it into the weak lamb’s mouth. Almost immediately, she said, the lamb would begin to suck on her fingers, and dull eyes became bright and weak legs strengthened—more evidence of the powerful effect that comes from even the tiniest amount of colostrum.
Sonja’s story shows how colostrum also has immediate benefits for sick human babies:
Sonja: When I learned I was pregnant, I already knew I wanted to have a natural birth. I couldn’t wait to have a beautiful birth experience that would give my baby the best start into this world. When I ended up with an emergency C-section, I had the most difficult time in my life instead. My baby boy was taken to the neonatal intensive care unit (NICU), and it was a long ten hours after his birth before I could even hold him in my arms for the first time.
I felt completely down when Eleanor, the breastfeeding consultant working for the hospital, entered my room and started talking to me about breastfeeding. She also showed me how to use the breast pump that was available in every room to stimulate milk production. Her words, her voice, and her calm energy were exactly what I needed to bring my focus back to being a mom for my baby. After my little baby boy latched on to my breast with ease, I gained a new powerful sense of motherhood. I still had something that only I could give to my precious boy—something that would help make him grow and get stronger.
I remember how later on, while I was breastfeeding my baby in the NICU, Eleanor went into my room to get the leftovers of my colostrum from the collection bottles. What I thought was just a few drops (not worth saving) amounted to a whole syringe full of colostrum. She brought it down to the neonatal care unit to store it in the refrigerator, explaining to the nurses the importance of breast milk, especially for the babies treated there. She said every drop was precious and mentioned that colostrum may even be used as a lotion for a baby’s dry skin. As a result, I asked the nurses to call me every time my boy needed a shot or a new IV, so I could breastfeed him before each procedure. This greatly eased his discomfort—to the point that he sometimes ignored the pain completely and did not cry at all.
Thanks to Eleanor, I had enough strength to be there for my little boy during those long seven days in NICU. And now I cherish each moment I can hold my son in my arms while I feed him, calm him, and comfort him. The connection I feel when I nurse him helps me forget the difficult past and gives me a feeling I would not trade for anything in the world.
The Beginning of Milk Production
On day two or three after most births, your milk will come in. You’ll know when this happens by the following signs: Your breasts will become warm and firm to the touch, and they will swell. Your baby, who suckled quietly when there was only colostrum in your breasts, may have to gulp at a fast rhythm to keep up with the flow. She will begin to pee larger amounts, and her poop will begin to change from the sticky dark meconium that clings to her skin to something that looks more like yellowish cottage cheese curds in yellow liquid. Breastfed-baby poop, unlike meconium, smells, but it’s not really stinky.
Your milk may come in either sooner or later than expected without there being an abnormality. For example, milk usually comes in earlier in women who have breastfed a previous baby, and it often comes in a day or so later when birth takes place in a hospital (especially when the mother has had little close contact with her baby or has been able to suckle her baby only according to scheduled times rather than by the baby’s cues).
Most women have the capacity to produce considerably more milk than one baby needs. Milk supply is directly related to the amount of milk that is removed and the frequency with which this happens—demand regulates supply. Your breasts don’t know whether they will need to produce for one, two, or three babies, and, as with certain other mammals, nature has provided you with the capacity to feed two babies simultaneously. It may also reassure you to know that research has shown that even women who are themselves malnourished are able to produce a sufficient supply of good-quality milk for their babies. They need only drink to satisfy thirst in order to produce enough milk. The rest of the job is about releasing that milk.
To keep producing milk, though—once your breasts really go into full production and your baby’s appetite is fully aroused—your breasts must receive the message of stimulation and, equally important, the removal of milk by suckling, manual expression, or pumping. If there is no frequent stimulation and removal, your milk will dry up over a few days.
The Letdown Reflex
When your baby suckles at your breast, the level of prolactin in your blood rises and stays high for the better part of an hour. This additional prolactin triggers the appropriate cells in your breast to make milk. Then comes a surge of oxytocin, which causes the contraction of the bandlike cells that surround the milk-making glandular tissue in your breast, squeezing the newly made milk into the duct system and out of your body. First-time mothers—like Franki, whose story is below—may be surprised and delighted to find out that they can shoot their milk several feet.
Franki: My first baby was three weeks old. I left for less than two hours to run some errands by myself, leaving the baby safe at home with Daddy. There I was in the grocery line, waiting to check out, fully armed with clothes, a good nursing bra, and breast pads, because my milk supply was bountiful from the time it came in. A lady and child behind me were arguing over gum, and the kid started crying and wailing, as some of them do at a time like that. Hearing that cry started my milk flowing, and by the time I got to the cashier, I was completely wet all the way through. My letdown was so strong I was actually tossing spots of milk on the floor and grocery conveyor belt as I unloaded my cart. The only thing that saved me from total embarrassment was that I knew the cashier, and we just laughed and laughed.
Some women feel the letdown reflex, while others don’t. Those who do feel it often describe it as a pleasurable sensation of warm tingling that moves from the breast cells close to the chest outward toward the nipple. But, as I implied above, it is possible for the milk-ejection reflex to be functioning perfectly without your feeling that tingle. (Smaller breasts tend to be more sensitive to this sensation than larger breasts.) Any baby who is well latched to the breast, sucking, and gulping is giving signals of a well-functioning milk-ejection reflex. You may have several letdowns in one feeding if your baby is sucking quite well. Multiple letdowns (whether you feel them or not) ensure that your baby gets the higher-protein, higher-fat hindmilk, which is let down after the thinner, more thirst-quenching foremilk.
Research has shown that the highest prolactin levels correlate with the times of higher milk production and that these occur between two A.M. and six A.M. after an evening of frequent breastfeeding with full emptying of both breasts.8 For this reason, women wishing to increase milk production are advised to get in a feeding or pumping session during this time period. See page 108 for more information on the letdown reflex.
Breastfeeding, like Birth, Works Best
When Stress Levels Are Low
When I was nine, I spent an entire summer with my grandmother and Aunt Myra on an Iowa farm. In those days on family farms, milk cows had pleasant lives, spending their days in pastures rather than in cramped feed lots. One of my chores was to round up the cows in one of the outlying pastures at sundown and herd them back to the barn. My aunt, knowing how impatient nine-year-olds can be, put me under strict orders never to hurry the cows from the pasture into the barn. “Horses and ponies trot, and that’s fine,” she told me, “but if you try to make a milk cow move faster than she wants to go, she won’t be able to let her milk down when she gets to the barn.” Years later, I reflected on these instructions when I was suckling my own children and understood that I had internalized something important from them that helped me when I was in the early years of my midwifery work. Milk flows best and most abundantly when the mother’s needs are understood and respected.
Several stress factors that are common to modern life can interfere with a woman’s ability to breastfeed. More often than not, these can be overcome, but it is necessary for you to know what they are so you can do everything possible to avoid piling up too many of them.
Every species of mammal needs the stress hormones that our bodies produce—adrenaline and cortisol—to help respond to dangerous situations, just as much as we need oxytocin and prolactin to help calm ourselves, recover from being in stress mode too long, and nurture our young. The calming and the stress hormonal systems are both part of the innate makeup of both genders, and ideally they should balance each other out. Adrenaline and cortisol cause several responses to occur simultaneously: Blood pressure rises, the heart beats faster, digestion slows down, and the organism becomes mentally alert and ready to fight or flee instantaneously.
Breastfeeding is easiest when the mother is not stressed—when, in fact, her family and the rest of her society give her encouragement and friendly support. If a mother is full of stress hormones, her oxytocin and prolactin levels will be greatly inhibited and her milk production may be much reduced or even temporarily stopped, as Melissa’s story shows.
Melissa: Baby Jeffrey was weighed and measured at his first well-child checkup at five days old. He nursed during the appointment, and milk was dripping from both of my breasts. Everything was fine, as we had expected, until the end of the checkup, when the doctor pulled out a weight chart and began to tap the buttons on his calculator watch. He said that Jeffrey had lost nearly ten percent of his body weight. He asked again if I was breastfeeding, and I told him that I was. Then the doctor told me that I should give Jeffrey a bottle in addition to nursing until his weight came up. I said that I didn’t want to do that—I wanted to breastfeed.
“I know you want to breastfeed,” he said. “Those Birkenstocks show me that you’re a hippie. But if you want to keep trying, you’ll have to go to the lactation consultant to make sure that it is all right.” Off we went to the hospital.
The lactation consultant weighed Jeffrey before and after I nursed him. She said that he was getting only a tiny bit of milk. Not enough. She told me to feed him formula and went to her supply closet, which was full of formula, and got some. I sat in the chair and cried. She didn’t even look at me. I was sent home with formula and a tube, as I had still refused to accept a bottle for my five-day-old son.
My milk dried up that afternoon from the stress and fright of that morning. All night Jeffrey tried to nurse, and nothing came out for him. The next morning, exhausted and sad, we went back to the lactation consultant for our follow-up. There we fed Jeffrey with the lactation aid. At home later, I lay on the bed and fed him with the tube. I hated it.
That evening, after a full day without my milk, I got myself together and decided how to heal. My husband, baby, and I loaded up in the car and took a drive. We got a pizza and a movie—our usual routine for Friday. It felt really normal, and we relaxed. Late that night, my milk came back in. Jeffrey regained his birth weight by the time he was two weeks old.
I don’t want you to think that all or even most lactation consultants or pediatricians would exhibit such uninformed attitudes toward breastfeeding. Many pediatricians and most lactation consultants would be aware that five-day-old babies usually haven’t yet recovered their birth weight and that a mother whose breasts are dripping with milk should not be discouraged from breastfeeding. And most lactation consultants would also be able to distinguish between a baby who is doing well with breastfeeding and one who actually needs supplemental feedings. Newborn babies tend to lose a few ounces (five to seven percent of the baby’s birth weight is average) during the first few days following birth, regardless of whether they are nursed or formula-fed. This weight loss is generally recovered by day ten to fourteen of life (if recovery of the lost weight takes more than two weeks, it’s best to contact a lactation consultant).
There’s a big difference between a baby who is a few days old and hasn’t yet regained her birth weight and one who is two or three weeks old and still under her birth weight. What Melissa’s story illustrates well is that her milk production and her milk-ejection reflex were both inhibited by the emotional upset caused by the lack of breastfeeding knowledge exhibited by this particular pediatrician and lactation consultant. The quick recovery of her milk supply when she decided not to be victimized by their words and advice was also a function of her return to a normal hormonal balance for a lactating mother.
I am certain that one of the reasons all the women in my community were able to breastfeed their babies was that we created a largely stress-free culture for women and babies without making life unpleasant for everyone else. To begin with, we didn’t have to encounter negativity about breastfeeding within our community, because if anyone disapproved, nothing was said aloud. Nobody gave us nasty looks when they noticed that we were breastfeeding. There were no worried grandparents among us who were trying to change our minds about the wisdom of breastfeeding instead of feeding our babies with manufactured milks. Everyone in our community, including those who had no children or were newcomers, soon came to understand what mothers and nursing babies needed. If those who joined the community had hang-ups about breastfeeding, they soon got over them. We actually learned how to get the right mix of hormones before we ever knew what the names of the hormones were!