Ina May's Guide to Breastfeeding

14
Shared Nursing, Wet-Nursing, and Forgotten Lore

When breastfeeding becomes marginalized in a culture, maternal behavior that was considered normal in times when people grew up seeing breastfeeding women around them comes to be viewed as socially unacceptable. Shared nursing and wet-nursing are examples of behaviors that have been common all over the world in nonurbanized societies. Unfortunately, when bottle-feeding of artificial milks becomes the primary mode of infant feeding, how people used to relate to one another can rather quickly be forgotten, and many begin to think that breastfeeding is—and should remain—an essentially private experience between each mother and her baby. Not only that, the marginal-ization of breastfeeding means that knowledge about the very capacities of women’s bodies to lactate gets lost to a surprising extent to women themselves and to medical professionals. In this chapter, I’ll explore these themes, their relevance to our own times, and the way I was able to regain some of the forgotten knowledge that it is still useful to have.

Shared Nursing

The first summer we settled on our land in Tennessee, we were presented with our first nursing challenge: One hundred of the three hundred of us came down with hepatitis A—probably from eating uncooked watercress that had been put in the store. Two pregnant women, Linda and Lisa, had their babies prematurely because of contracting the disease. Both babies were too small to maintain their body temperature, even in the August heat, so each spent some weeks in incubators at our local hospital. Hospital policy in the nursery at that time didn’t allow for mothers to even hold their babies, let alone nurse them, so both were given formula milk by bottle for the duration of their hospital stay. It was clear to me that the main way we could help Linda and Lisa was to keep their milk flowing so that when their babies were finally discharged, they would be able to switch from formula given by bottle to drinking their mothers’ milk directly from the breast. I hadn’t yet heard of “nipple confusion,” so I didn’t know that babies sometimes become lazy about nursing because of habits they form from bottle-feeding, and I didn’t foresee any problems. Breast-pump technology was in its infancy in the early 1970s; we had some manual pumps of the old bicycle-horn type, but nothing like the electric pumps of today. I did know that milk had to be regularly removed from each mother’s breasts to keep up milk production. Although Linda and Lisa had some degree of success pumping manually, it was obvious that stronger measures would be necessary for them to maintain good milk production. At my suggestion, some of the other mothers of young babies in our community worked out schedules among themselves and helped Linda and Lisa keep their milk supply abundant by bringing their own babies to their homes to be nursed by them.

Perhaps because in 1971 the very act of breastfeeding a baby was considered a radical thing to do, it didn’t seem to us much more radical to occasionally nurse one another’s babies if and when it became necessary. This arrangement certainly helped Linda and Lisa keep their milk flowing, emptying their breasts far better than they could achieve with the manual pumps. After discharge from the hospital, Linda’s baby, who had been the smaller of the two, required some supplementation with formula for a while, but both of the preemies were eventually able to breastfeed exclusively.

When women have strong friendships, trust one another, are healthy, and live close together, breastfeeding one another’s children occasionally can be convenient and helpful. In the early years of our community, the overall budget didn’t permit us to build single-family dwellings, so our solution was to build some houses that were large enough to be shared by three or four families and some single people as well. Under these circumstances, close friendships developed among many of the women. We midwives, for instance, all had young babies during the early years; when we were called out to a birth, we couldn’t always take our babies with us, so one of our housemates would ordinarily make sure they were fed. If my baby was asleep and not yet ready for a feeding when I was on a lecture tour in our large bus (accompanied by a rock band and their families), I would feed the baby who was awake and most ready to eat, and that baby’s mother would then feed my baby when he woke up. As one of my friends put it, “It seemed like a pretty natural part of life, especially among us women who knew each other so well and were so comfortable with each other. It was occasional for most but just not a big deal.”

At the same time, the women of my community did find it necessary to develop an etiquette surrounding shared nursing. We agreed, for instance, that asking to breastfeed another woman’s baby out of mere curiosity was impolite and intrusive and shouldn’t be done.

On the other hand, I remember how much I ached to have a live baby at my breast during the first days of grief I experienced after the death of my prematurely born son in 1971. I don’t remember now if the mother of one of the babies whose birth I had most recently assisted offered that I could nurse her baby or if I dared to ask her permission, but I do know that I nursed her daughter for a few healing minutes when I was still raw with grief. My son’s death had made me understand in a visceral way why grieving mothers sometimes steal someone else’s baby; those few moments soothed something very deep in me, and my healing began.

A few years later we had a situation in my community that called for helpful intervention. A woman named Eileen had given birth to surprise twin girls ten weeks early. Each baby weighed 3 pounds 5 oz. (1,500 g). One of the girls had respiratory-distress syndrome followed by pneumonia and needed to be on a respirator for almost a week. Eileen pumped her milk nine times a day and brought it to the nursery where the girls were being kept. First the babies were tube-fed, and then, when they got stronger, they were bottle-fed. Both babies were well under five pounds when they came home and were mainly bottle-fed Eileen’s milk (with only one nursing per day). Eileen eventually quit pumping and began nursing them a lot, and they quickly began to prefer nursing. The twins did well, but Eileen and her husband, Matthew, were bleary-eyed with exhaustion. Around this time there was another crisis, involving a first-time single mother, Karen, whose baby died because of a prolapsed cord at the onset of labor (Karen’s lower limbs had been paralyzed by polio during childhood). It occurred to me that the two women might be able to help each other, if they lived in the same house and all were open to the idea of Karen helping to nurse the twins. The three adults agreed to try this.

 Karen: I moved to Eileen and Matthew’s house and was handed a hungry baby right away. I remember it being awkward at first, because I didn’t really know these people nor did I know how to nurse a baby. I learned fast. The girls were always ready to eat. By the time I got to them, they were two months old and around six pounds each. At first my nipples got very sore, so I used a nipple shield. But the twins didn’t like it, and I soon got used to them nursing. The twins would nurse for hours, regardless of my milk supply. I could nurse them both while lying on my back, propping them up with pillows. I loved nursing; it felt good and it helped me get over the loss of my own child.

 Eileen: It became apparent that the only way for us to do it together was as a full partnership. We both shared both twins. At night, one baby would sleep in each of our rooms, alternating which baby each night.

 Karen: The twins grew fast. Their bony butts filled out, and they were actually fat by five months old. My love for the family grew too. They let me help care for their babies, which is what I most needed at that time in my life, and I gave them the help they needed. Eileen and I naturally had different parenting styles, but we respected each other and helped balance one another out—keeping each other clear of all the pitfalls of a first mothering experience.

The twins did not seem to care that one of their mothers was biological and one was not. When they started to talk, we were both “Momma.” People remarked on how much the twins looked like me, which is understandable, since they spent many hours staring at my face. The twins are grown women now. I am grateful that such an intimate and compassionate arrangement could happen and that everyone could be the better for it.

  Sometimes nursing someone else’s baby is a one-time-only event. I can remember a birth to a single mother after a long, exhausting labor. After an hour or so spent trying to get her baby to latch, she was becoming frustrated, which was preventing her baby from calming down enough to take her breast. Noticing that she was near tears, I finally asked if she’d mind if I showed her baby by letting him latch on to my breast. (It was the quickest thing I could think of, as I hadn’t yet been able to talk her through steps that would work for her.)

“Would you, please?” she asked. After a few sucks at my breast—and a perfect latch—her newborn son was handed back to her. He, now calm and having learned what to do, latched on to her breast without hesitation.

Problem-solving during the early days sometimes went like this, especially when mother and baby were having trouble getting the hang of nursing and both were getting frustrated. The women in my community were generally aware that:

·   When a new mother has trouble getting her new baby to latch correctly, an experienced baby can efficiently teach her what a correct latch should feel like.

·   When a new baby is having a difficult time latching correctly and there is no lactation consultant available, time and frustration can be saved by having an experienced, healthy mother teach her.

I’m sure that we avoided many cases of sore nipples in this way during the early days, when we hadn’t yet learned about other techniques for dealing with this type of problem.

The following story illustrates how a sisterly relationship made one baby’s hard transition into life a little sweeter.

 Malika: After my sister-in-law had a traumatic delivery in the hospital, the nurses insisted that the baby be given formula due to low blood sugar. My phone rang at 3:00 A.M., with my sister-in-law’s pleading voice on the line. Her pediatrician had reluctantly agreed to let her baby have my breast milk instead of formula. So, with my infant son in one arm and breast milk in the other, we trekked into the nursery in the wee hours of the morning. The nurse blankly stared at me in disbelief when I announced that I was there with milk for my nephew. She had such a prissy look on her face that I offered to nurse him instead. “Oh, that won’t be necessary,” she said, and took it from me with gloved hands, all the while repeatedly telling me this was against policy and that she was very unsure of it. I watched her feed my nephew, who clearly loved it and was very grateful. The worried look disappeared from his face. The good thing was that he didn’t need formula after all, because his mom was able to nurse him not long after he got my milk.

  Malika’s story also illustrates how widely attitudes vary about mother’s milk in our country—not so much regionally but rather among individuals. To some (including me), breast milk is the perfect food for babies and, as such, it is different from every other secretion of the body; nothing else we secrete is food. Others worry about it precisely because it comes from the body, and they are not differentiating between food and other bodily fluids.

I had thought until recently that the women of The Farm were perhaps the only women in the United States who sometimes shared milk with one another’s babies. After all, the websites for the Centers for Disease Control and La Leche League both discourage the practice, citing the possibility that another mother might have a serious contagious disease. It is certainly understandable why the CDC and LLL have not given their stamp of approval to informal arrangements for the sharing of human milk, given that breastfeeding is considered a possible way of transmitting the HIV (AIDS) virus. Both the CDC and LLL recommend that any mother needing human milk for her baby, who can’t provide her own, should buy it as a prescription item through a human milk bank. However, given the high price of human milk obtained at such banks in the United States (three dollars per ounce) and the average three-month-old baby’s need for twenty-five to thirty ounces per day, the cost is clearly prohibitive for many mothers who nevertheless want the benefits of breast milk for their babies. Shared-nursing arrangements are particularly useful to adoptive mothers who haven’t been able to successfully induce lactation and to mothers whose previous breast surgery interferes with milk production or transfer. Women in these situations may make arrangements with trusted friends or relatives who can provide breast milk, saving themselves the steep costs of milk banks.

I have noticed, however, that in recent years a growing number of breastfeeding mothers have been telling stories of sharing their milk with one another’s babies in different publications and on the Internet.1–3 Such arrangements are usually made on an informal basis involving family members, close friends, or neighbors who are in a position to know one another’s health status. There are several factors behind this trend. First, it shows that many women have accepted the message that breast milk is the best food for babies. Second, the Internet offers many ways for women to share information, stories, and ideas. Third, the short unpaid maternity leave for most U.S. women (with a general lack of employer accommodation for breastfeeding) has motivated some mothers to seek a way to make sure their babies receive breast milk.

In some families, the practice of women sharing nursing is part of a culture that has been long accepted. Brenda explains:

 Brenda: I am the youngest of five children—four girls and one boy. All of my siblings, including my brother’s wife, had natural births and breastfed. We all helped each other out with child care. Our children were often close in age and breastfeeding at the same time. If we were watching our sister’s or sister-in-law’s baby and it was hungry, we breastfed it. This was just common sense. The baby was satisfied, and the mom didn’t need to worry while she was away. These children played together, grew up together, and still maintain close relationships. They have a great deal of fun together now as adults.

  Another relationship was that of a thirty-year-old Tucson mother who offered this service to her sister, whose prematurely born baby needed breast milk just as much as his mother needed the income from her job as a waitress. Since her employer wasn’t willing to make arrangements that would allow her to continue nursing her baby during the day, this woman’s sister nursed the baby (as needed) while she was at work. In quick trips to the bathroom, the mother was able to manually express enough milk at work to relieve her overfull breasts, and she nursed her baby at night. The cooperation between the two women eased a difficult situation for the working sister and her baby.

Muslim societies recognize the special closeness of babies who have been nourished at the same breasts, even when the babies are not related by blood. From the Muslim perspective, because milk is so close to blood, the relationship of babies who share the same mother’s milk is considered to be as close as that between siblings. This means that a young woman who would have to be veiled in the presence of any men outside of her immediate family would not be required to wear the veil in the presence of a “milk sibling.” Milk siblings should not marry each other, for this same reason.

Breastfed babies are often curious and adventurous when they see attractive breasts.

Shared nursing may not appeal to every mother, nor is it practical for many women. At the same time, in some situations and cultures, shared nursing involving women with no communicable diseases makes sense and promotes a tender closeness between the women who share this aspect of their mothering. HIV testing would seem to me a sensible precaution before embarking upon such an arrangement.

Wet-Nursing

We know from written and pictorial records that for centuries women in various parts of the world have nursed babies besides their own. Wet-nursing was a common feature of life in ancient civilizations such as Babylon, Mesopotamia, Egypt, and Sumeria, according to several references dating from the third millennium B.C. These range from ancient lullabies to legal contracts between families and wet nurses. A contract might, for instance, spell out the length of time that the hired wet nurse would be expected to nurse the child and might specify that she was not to become pregnant or suckle another child (including her own) during that period. If midwifery was women’s first profession, wet-nursing was probably the second.

Who were these wet nurses, and how were they able to do their jobs? We know that in any given population some women can produce so much milk that they can feed several babies with ease. According to Jane Sharp, seventeenth-century English midwife and author, “Some women… are so well tempered to increase milk that they can suckle a child of their own, and another for a friend; and it will not hurt their own child.” Presumably, many women with this ability must have found employment as wet nurses. In sixteenth-and seventeenth-century England, nearly all of the wet nurses were married women living with their husbands, with children of their own. Some may have had to abandon their own babies to another’s care while they served as wet nurse for the baby of someone who could pay them. Some of the earlier references tell of wet-nursing without any commercial relationship between the two women. The Old Testament story of Ruth, for instance, tells of Ruth giving her son to her mother-in-law, Naomi, to nurse.

Not surprisingly, the practice of using wet nurses (whether or not they were paid for their services) seems to have been especially common among royalty and people of wealth. Women who were poor or penniless probably had little choice about taking up wet-nursing in many cases. One of the reasons why some royal families employed wet nurses during times past was that people knew a woman’s return to fertility could be delayed by exclusively nursing her baby. Giving a newborn to a wet nurse would hasten the queen’s next conception and make it possible for her to give birth to more royal heirs than would have been likely had she nursed all of her children herself.

It might surprise some people to know that wet-nursing is not a thing of the long-ago past in many parts of the world. I learned this in 1965 while working for a few weeks in a Chinese boatbuilder’s yard in Penang, Malaysia. The boatbuilder’s wife had given birth to a baby a few months previously. I remember her situation as being somewhat unusual (for me), since her baby was being wet-nursed elsewhere in Penang and wouldn’t rejoin his biological family until he was weaned during his second year of life. This middle-class family took the wet-nursing option because they believed that human milk was far superior to artificial formula milk, which was being heavily promoted to Malaysian families at the time, but they also believed that it would require too much of the mother’s energy to nurse her own baby.

Wet-nursing is making a modest comeback in the United States, for the same reasons that shared-nursing arrangements are being made. A Los Angeles-based agency serves women who can afford to hire a wet nurse, typically at a rate of $1,000 per week. One such wet nurse nursed ten babies over the previous seven years as a way of funding her own children’s college educations. Asked if she thought less of herself for earning money in this way, she answered that she found it fulfilling.4

As China has modernized, breastfeeding and wet-nursing rates have dropped rapidly—more women have returned to work soon after giving birth, and infant-formula companies’ aggressive marketing techniques have reached more people. However, the poisoned-infant-milk scandal that erupted in September 2008 sparked a reconsideration of the worth of breastfeeding and wet-nursing in China. Millions of parents found out that the infant formula they had been told was healthier than mother’s milk was actually heavily contaminated with melamine, an industrial chemical meant to fool tests for protein in watered-down milk. As a result, at least six babies died from kidney stones and some 300,000 others suffered serious urinary and kidney problems that may be with them for their entire lives. Suddenly, Chinese parents, feeling betrayed by their government’s food-safety agencies and many domestic infant-formula companies, began to search for women to serve as wet nurses to their babies, and lactating women began to realize that their milk was valuable enough to be advertised via the Internet. Wet-nursing clearly is making a comeback.

Forgotten Knowledge

When humans set aside a biological activity and rarely perform it in significant numbers, the knowledge of the activity within that culture can quickly vanish to a degree that is astonishing. The following story, told to me by a Dutch midwife, serves as an example of what I mean. The Netherlands, like other Western countries after World War II, moved toward widespread acceptance of bottle-feeding babies with various formulas based upon cow’s milk, even though a larger proportion of the Dutch population stayed with breastfeeding than that of the United States around the same time.

The Dutch midwife told me of a conversation she had with a young woman who had recently become pregnant with her first baby. Like many Dutch women, she came to the midwife intending to have her baby at home. Typically, this would be an unmedicated birth. “That’s wonderful that you are pregnant,” the midwife told her. “Are you planning to breastfeed your baby?”

“Oh, no,” said the young mother-to-be. “I really can’t stand any pain.”

“Why do you think that breastfeeding a baby is painful?” asked the midwife, surprised that someone choosing to have an unmedicated birth would be hesitant to breastfeed because of fear of pain.

“Well,” replied the young woman, “don’t you have to make holes in the nipple with a needle?”

Dumbfounded at first, the midwife realized—after continuing this discussion for a while longer—that when the young woman was a child she had seen her mother enlarging the hole in a rubber nipple. Having inspected her own nipples without finding any visible holes, she assumed that such holes would need to be created with a needle.

I can promise you that if this story was told anywhere in the world before 1900, it would have been hard for anyone to believe that a young adult could be so ignorant. If you told that story today to someone who grew up in a village in which every baby is breastfed, they would be amazed that someone in this day and age could know so little about her own body. And yet I have a story that illustrates that even the most highly educated authorities in our culture may have similarly breathtaking gaps in their knowledge and understanding about breasts and breastfeeding.

Five of my friends and fellow community members took an anatomy and physiology course at a college while studying to be registered nurses. While lecturing on the structure of the female breast, the instructor of the course (who had a PhD in his field) mentioned in passing that milk came out of a hole in the nipple.

“Do you really mean only one hole?” one of my friends, who had breastfed five children, asked, half-suspecting that she had heard him wrong.

“Yes,” he said confidently.

One of the other women from The Farm raised her hand and tried a different approach. “But our textbook states that there are several holes in the female nipple,” she said, pointing to the book on her desk.

“Oh, that’s not the text that I use for my final authority,” he replied. “Come down to my office after class, and I’ll show you.”

Worried that they would embarrass their professor before the entire class more than he had already embarrassed himself, they left the subject until the class was over, wondering all the while if he really thought that the textbook he had chosen for their course was wrong in such an important detail. Once they were all in his office, he reached for the “more authoritative” textbook from his shelves. Opening it to the crucial page, he quickly realized that he had been wrong. Finally humbled, he turned to my friends and asked, “How did you know?”

“Among us, we have breastfed seventeen children,” one of the women answered for all.

This story illustrates several facts. The first may surprise many academics—not just the professor mentioned; Women who have breastfed are themselves an important source of knowledge about breastfeeding. None of my friends found it necessary to read a textbook about how many holes there are in the human nipple, any more than a man would need to be told how many holes there are in his penis. They learned from observation, just as the man does. But there is a difference: Unless the woman’s breast is producing colostrum or milk, she is not able to see how many holes there are in her nipples. Second—and this is a really important point—written knowledge can easily be forgotten when it is not backed up by bodily experience. No one who has ever seen milk spray from a breast could be fooled into thinking that there is only one hole in a woman’s nipple.

The anatomy professor is just one example illustrating the confusion of societies in which most people live in a way that has become quite disconnected from nature.

A person who grew up on a farm would never have made this kind of mistake. Even if they had never seen a human female nursing a baby, they would have witnessed all of the farm’s animals feeding their young in the way that nature intended. However, with fewer and fewer people having grown up on a family farm, ignorance of the capacities of the human body becomes more pronounced and widespread. It doesn’t take very long before human abilities that were common knowledge for thousands of generations become shrouded in mystery.

Sometimes the level of ignorance is beyond what I would have thought possible. It wasn’t long ago that I met a young woman, now a medical student, who had an interesting story to tell me.

 Gretchen: When I was pregnant with my first child, my nurse-midwife asked a typical prenatal question: “Are you planning on breast-or bottle-feeding?” Puzzled, I looked to my husband for guidance, as this was his third child and I relied on his experience quite a bit during the pregnancy. He emphatically suggested I at least try to breastfeed. The problem was that I didn’t know what breastfeeding was. My midwife suggested I attend a La Leche League meeting during my pregnancy, as the leaders there would be able to answer any questions I had. A few days later I found myself sitting in a library meeting room surrounded by women who were feeding their babies, but not with bottles—the way I thought babies were fed. They were all breastfeeding. Until this point in my life, I had no idea that breasts were for feeding babies. I didn’t even know we were capable of feeding babies with our breasts. This was something I don’t ever recall being told, nor do I have any memory of ever seeing a woman breastfeeding a baby prior to my first La Leche League meeting. I was twenty years old and had just discovered the real purpose for breasts!

I educated myself more about breastfeeding and decided I would at least give it a try. I gave myself a goal of one year and no more. I then went on to nurse my firstborn for two and a half years, including through a pregnancy. He weaned when his sister was nine months old, and she weaned when she was about two and a half as well. I never could have imagined how important breastfeeding would be for me, and I am very thankful I have a husband who helped me discover what my breasts are really for.

  In case you think I have already exhausted the modern-day fund of ignorance that plagues many highly urbanized societies, read on. Take the little-known fact that there is plenty of evidence that many women who haven’t been pregnant recently can fully lactate, stimulated primarily by a baby’s sucking at the breast. One of the neatest talents breasts have is that they don’t really retire, or, if they do, they can be called back into service. That’s right: Many grandmothers can suckle their grandchildren, if need be, and within a few days’ time (usually) be able to keep up with a baby’s nutritional needs. This has been the case throughout time, and there are still many groups of people who continue to hold this important cultural knowledge and use it daily to make life easier for mothers and babies.

I didn’t learn about this ability from books—although it has been briefly mentioned in several texts on lactation. Generally, it is discussed with reference to women in nonliterate societies or from the distant past. Breastfeeding self-help books mention “induced lactation” in the context of providing strategies for women whose babies are adopted, generally advising that the mother use a lactation aid, a variety of medications, and breast pumps. Even so, most people in our culture would be amazed to find out that it is possible for some women to produce milk even if they have not recently (or ever) been pregnant and given birth.

My own first experience with a baby being nursed by someone other than her mother took place in Malaysia during the 1960s when I was in the Peace Corps. Shortly after our arrival in Malaysia, a group of fellow volunteers and I were invited to have coffee and conversation at the home of the headman of a Malay rural village. Excited by the chance to be in a real Malay home on stilts, we climbed the ladder to the doorway one by one and were greeted by the headman and his young wife. They invited us to sit on the grass mats surrounding the low table set with coffee cups. Two older children played quietly in a corner, under the watchful eye of their grandmother. But that wasn’t all that this colorfully clad woman was doing. To my complete surprise, I noticed that she was cradling and nursing the youngest child of the family. The Peace Corps had spent a lot of time during our training period trying to prepare us to live in this non-Western Muslim culture. We learned never to point with our index finger, beckon someone with our palm upward, eat with our left hand, show the soles of our feet, or pass before someone else without first crouching enough that our head would be lower than theirs. But no one had prepared me to see an elderly-looking grandmother nursing a baby. Because her breasts were so empty-looking, I assumed that her grandchild was enjoying suckling but wasn’t getting anything to drink in the process. Little did I know at that time that breasts don’t have to look full to be able to deliver plenty of milk.

Years later, after I had been a midwife for ten years or so and all of my children had been nourished at my breast, I had another chance to be among women and babies from an entirely different culture. This time I was spending a couple of weeks in Lesotho, an impoverished country whose only neighbor is the Republic of South Africa. While there, it was impossible to forget that Lesotho depends heavily upon foreign aid to feed its people because of the deforestation and subsequent loss of topsoil that occurred during the colonial period a century and more earlier. At any rate, during my time there, I came into contact with several grandmothers who were nursing children who appeared to be three or four years old. Again, I assumed that they were not actually nourishing these children.

It wasn’t until I ran across a fascinating passage in a nineteenth-century medical text a few years later that I realized I was unaware of all the capacities of women’s bodies. The passage was written by M. Audebert, a well-known French obstetrician, and referred to a case he learned about in 1841:

Angeline Chaufaille, sixty-two years of age, and who had not had children for twenty-seven years, undertook to nurse her granddaughter artificially. From time to time, in order to amuse it, she presented it with her nipple, but what was her surprise when she suddenly found both her breasts full of an apparently good, healthy, and nutritive milk! She continued to nurse it for a year, and the secretion had not entirely ceased after the child had been weaned two months. At this juncture, her daughter again became a mother, her milk dried up, and the grandmother was able to nurse the second child.

When I read that passage, I realized that there was a good chance that the Malay grandmother and those older women I had seen in Lesotho had been lactating as well. What’s more, none of these women had needed to use a device to deliver a substitute milk through a tube taped to their nipple in order to keep the baby stimulating the breast.

From that time on, I kept my eyes and ears open for more information on the subject. Here’s what I found. Gabrielle Palmer’s book, The Politics of Breastfeeding, references nineteenth-century England’s famous Judith Waterford, whose amazing ability as a wet nurse was documented in both medical and lay publications. At the age of eighty-one, Waterford demonstrated how she could still squeeze milk from her left breast that was “nice, sweet and not different from that of young and healthy mothers.” After her marriage at twenty-two, she spent the next fifty years nursing babies—six of her own, eight nurslings, and many more for friends and neighbors. By the age of seventy-five, she regretted that she could feed only one baby at a time.5

I also found an extensive article published in 1940 in the Bulletin of the History of Medicine. Its author, H. A. Wieschhoff, discovered many reports published between 1640 and 1935 of women in primitive societies in Africa, Indonesia, India, North America, South America, and New Zealand, which were familiar with, and even dependent upon, the ability of a woman to resume lactating many years past the birth of her youngest child. An English writer, for instance, who had spent time among the Lepcha people of northern India wrote: “… any woman who once has given birth to a child is believed to be able to ‘produce milk spontaneously when a baby sucks.’ “Among these same people, he went on, “it is the obligation of the grandmother to suckle the child should its own mother die.”6

A German ethnologist who lived among the Xhosa people in southern Africa for more than four decades in the last half of the nineteenth century wrote that this phenomenon was common among these peoples and stated that he had learned of “numerous” cases in which women from sixty to eighty years of age were able to suckle their daughters’ children or even their own great-grandchildren.

The oldest reference in the 1940 article was to a report made by a Jesuit who visited the Iroquois people in 1640 and wrote: “Here is an occurrence which many have considered remarkable. There was a woman who had had nine children, the last of whom was married, and had children; I mean to say, in a word, that this woman was very old—I believe that her age was more than 60 years; yet one of her daughters happening to die, and leaving a child in arms, this good old woman took the child and offered it her withered breast. The child, by pulling at it, caused the milk to return, so that the grandmother nourished it for more than a year.”

Wieschhoff’s 1940 article also mentions that Dr. David Livingstone, the medical missionary who searched for the origin of the Nile, wrote in 1858 that he had witnessed many cases during his travels in which a grandmother was able to nourish a grandchild at her breast, stating that sometimes mother and grandmother shared in suckling a baby.

The ability of elderly women in medieval Europe to lactate has also been noted in some sources. In Bologna, an elderly couple adopted an abandoned baby and, after some prayers, the wife found her breasts full of milk and was able to nurse the baby. And in Tuscany, church frescoes show the “miracle” of a seventy-five-year-old woman who was able to nurse her grandchild for several months after both parents had perished in the plague.7

Recently I met a young nursing student named Albert. When I asked members of his class if any of them were aware of the ability of grandmothers to lactate, he told me his story.

 Albert: My mother had a complication with my birth, so she was hospitalized for a couple of weeks. During this period, it was my grandmother who took over nursing me. She said that at the age of forty-eightshe would wake up in the middle of the night to feed me or change my diaper. Maybe this is the reason for the strong bond I have with my grandmother. I am actually her favorite among her grandchildren. When my mother recovered from her illness, it took some time before I was able to make the transition back to her (I know there is no rationale for this, but it just happened). They said that I would cry and cry for my grandmother.

  In case you wonder how—apparently independently of one another—indigenous and ancient peoples in so many parts of the world discovered that grandmothers can often lactate long past their own childbearing years, I’d like to suggest how this might be known. Many women have told me—and I have experienced this myself—that when they hear a baby cry, they sometimes feel a tingling sensation in their breasts that is very much like the feeling of milk letting down when one is already lactating. I would call this a prolactin rush. Although I have never breastfed a baby since I weaned my youngest child, I have always had the feeling that my milk would return if I tried breastfeeding. I am reasonably certain that I am not the first nor will I be the last woman to have this feeling.

Sharon, although not many months past weaning her son, learned to her surprise how quickly milk can return.

 Sharon: My friend from Oregon came to visit us during a beautiful, snowy winter in Minnesota. My sons were five and a half and three and a half, at the ages where they loved sledding and building forts in the snow. Dawn’s son, Morgan, was just four months old and preferred to stay inside and snuggle. I was more than happy to provide the arms for snuggling, while Dawn was content to bundle up and play in the snow with my sons. Morgan woke up while they were all outside and was rooting at my breast. He had done that with me earlier and Dawn had said I could offer him my breast. I did just that and he snuggled right back down, content to be suckling (his mama had fed him not long before). I wasn’t producing milk any longer, as my youngest had weaned several months earlier, so I was surprised when, after suckling off and on over a few hours, Morgan pulled away wide-eyed to look up at me and there was milk dribbling from both his mouth and my breast.

To be able to make milk at all is a wonderful feeling. It’s impressive—so much so that, after you wean your baby, you might even become curious to know if you can still express some milk from your breasts. I found that I could still do this more than twenty years after weaning my last child, and this is not unusual, as I’ve talked to more women than I can count who could do the same thing. Women in indigenous societies have, no doubt, experienced similar feelings, and they have the additional advantage of having grown up observing older women in their own villages nurse their grandchildren or adopted babies.

Of course, the baby has to be a willing participant in getting Granny’s milk to start flowing again. In case anyone thinks that a baby might find Grandmother’s breast too wrinkled to be attractive, think again. To babies, breasts are breasts, and they are not at all put off by the age of their owner. Babies love breasts, and they love them with absolutely no reservations, guilt, or shame.

It should be mentioned here that babies do recognize differences in the milk of their mother and that of another. As discussed earlier, the baby who is allowed to lick her mother’s nipple during the few minutes after birth will be able to reliably distinguish her own mother’s breast pad by smell from the breast pads of other mothers. Even with this ability to distinguish her own mother’s milk, a hungry baby will nurse from “strange breasts.” Some older babies or toddlers are adventurous in their tastes too. I remember one little boy of my acquaintance, whose full-breasted mother had nursed him for a year and a half. He had just turned two and was cuddled in his babysitter’s lap, his face just even with the small breasts under her T-shirt.

“Is there any tits in that shirt?” he asked.

“Yes,” she laughed, never having been asked such a thing before.

“Can I eat them?” he asked quietly.

Spontaneous Lactation

One day I was talking to a group of young women who were studying to be doulas, and I mentioned the ability of grandmothers to relactate. After the class, one of the women came up to me and said that she had had an interesting experience as a teenager that I might want to know about. It seems that she had been raised by a single mother and that she and her mother had often lived with other single mothers and their children. As the oldest child, this meant that she had a lot of contact with young babies as she was growing up. When she was fourteen or fifteen years old, she had a babysitting job for a couple of doctors with three children, one of whom was a very colicky baby about five months old. This young woman, Elizabeth, was extremely conscientious in how she cared for these children. On this particular day, she continued to hold the fussy baby in her arms over a period of hours, always trying to comfort him as she cared for the older children. Several hours had passed this way, without the baby quieting down for a nap. She was standing at the stove, still holding the baby and heating up some food for the older kids, when she felt a tingling sensation all over her body and a sudden wet feeling on her chest. She was astonished to see two wet circles forming on her T-shirt just over her small breasts, and the baby was diving toward them. Realizing that this was milk, she took the most practical approach she could to the situation and sat down in a comfortable chair, lifted her shirt, and allowed the baby to suckle. He gulped noisily for several minutes before falling into a deep sleep, satiated and blissful.

When the parents returned home, she told them what had happened. They had no problem with what she had done but were instead happy to know that their baby was sleeping and calm. Elizabeth told me that when her mother arrived to drive her home, she asked her to stop by a department store to buy a bra to help disguise how big her breasts had suddenly become. “I’m going to get such a hard time from the other kids,” she told her mother. Elizabeth told me that her breasts were still full of milk until her period returned. She was twenty-five at the time she told me this story and said that she still felt the letdown reflex whenever she heard a baby cry and had to press on her breasts to keep them from secreting milk at such times.

Though not common, Elizabeth’s experience was not unique to her. Returning to H. A. Wieschhoff’s article, I found this reference to spontaneous lactation in the part of the article devoted to India: “… the Lepcha maintain that women who have never borne a child can produce milk which may be indigestible at first, but later becomes satisfactory.” In addition, the superintendent in a hospital in Rajputana remarked that he had observed a Muslim woman, forty years old, “who had never borne children, nor had anything like an abortion in all her life. She was seen nursing her husband’s grandchild by another woman and had done so for many months.” According to the woman, the flow of milk was copious and was quite enough to satisfy the child.

Another young woman, Maria, told me of a similar experience she had—spontaneous lactation without ever having had a pregnancy. On impulse, I asked her if this experience involved a baby that she loved. Surprised, she answered that, yes, it did. She was living with her boyfriend, who had a six-month-old baby with a former girlfriend. The boyfriend was being allowed to care for the baby over the weekend for the first time. Maria, who was holding the baby while taking a warm shower, was surprised to notice milk spurting from each of her breasts.

Months later, at a routine gynecological examination, Maria was asked to fill out a form about her medical history. When she came to the question asking whether she had ever experienced a “discharge” from her breasts, she told me that she had answered yes—although she didn’t really consider milk to be a discharge. To her surprise, the doctor ordered a CT scan, thinking that this symptom made it necessary to rule out a brain tumor. While spontaneous lactation can be a symptom of a brain tumor near the pituitary gland, it seems that most medical professionals no longer recognize that a healthy young woman with an extraordinary sympathy for babies can lactate spontaneously from nonpathological changes in her hormone levels.

Chloe’s story illustrates how forgotten knowledge creates a narrowed view of women’s bodies, so that phenomena that happen to especially sensitive women are seen as evidence of pathology. Only when women feel free to tell their stories can we begin to get an idea of the incidence of spontaneous, nonpathological lactation. My own sense is that it is much more common than we believe.

 Chloe: In 2002, when I was twenty-two years old, I started working as a health-care assistant on a maternity unit while I was waiting for my nursing course to start. I’ve wanted to be a midwife since I can remember. It feels like something I was born to do, so when I started working at my local maternity unit, I just loved going to work. Mostly my duties consisted of breastfeeding support and general care of Mum and baby on the postnatal ward, with some occasional labor and birth support.

A few months after being in this job, I was washing in the shower and noticed small amounts of yellow/white fluid at the end of my nipple. If I squeezed my breast to the end of my nipple, more would come, although not a lot. Having been providing breastfeeding support, I knew this fluid looked like colostrum or milk, and I was confused and concerned as to why this was happening. I asked my partner at the time if he had noticed anything, and he said that it was something he’d noticed recently but hadn’t thought to mention it. I think the both of us were embarrassed; I know I was.

I made an appointment with my general practitioner (GP), who wanted to do a blood test, which I had, and when I returned for the results I had a high level of prolactin. When I asked my GP what was causing this, he was reluctant to enter into any discussion and referred me to an endocrinologist. When I saw this doctor, he told me that the rise in my hormone level could be due to a problem in my pituitary gland, which could be caused by a tumor. I was obviously extremely worried now, made worse by a long period of time where I had to wait to have an MRI, a bone scan to check my bone density, and an abdominal scan to check my ovaries. Nothing was found to be wrong, and the doctor was unable to tell me what was causing my prolactin level to be so high. Although relieved not to have a tumor, I was still made to feel there was something wrong, and I was also worried about the effects on my fertility. He gave me some medication, which I can’t remember the name of, and I took this for three months with no change. I finally decided that I didn’t want to be on any medication and I would leave things as they were. Having separated from my partner, I wasn’t feeling embarrassed in front of anyone at present, and I pushed it to the back of my mind and got on with my nursing course.

I am now about to qualify as a midwife, and to this day I continue to lactate. It very rarely leaks from my nipples without some form of pressure applied to my breast, although there have been times during a birthing that it has. I have become very used to this and personally I don’t really mind. However, it has stopped me being intimate with men, and I haven’t had a relationship since—although I’m sure there are other reasons for this than just my lactation. I am still embarrassed, especially as when my breast is squeezed the milk can spurt out a lot. On a recent visit to The Farm, however, I met another woman who experiences this, who has a happy marriage and beautiful children. Ina May also suggested to me that it may not be such a coincidence that this began when I started my job, given that I love it so much and that I might actually be experiencing higher levels of oxytocin, which, in turn, trigger the prolactin. Suddenly—and I can’t believe I haven’t made this connection myself—-I feel like I’m not ill or weird but just highly sensitive to my job and the women I care for, and I wouldn’t change the way I am for the world.

Some of the best advice I got from my high school education was from my biology teacher, who told our class: “Always keep your mind open to new opportunities to learn.” I continue trying to do that.