Ina May's Guide to Breastfeeding

Creating a Breastfeeding Culture

Isometimes wonder what nineteenth-century women’s rights leaders such as Elizabeth Cady Stanton, Susan B. Anthony, and Sojourner Truth—had they been able to peek into the future—would have made of the lack of social and cultural assistance and acceptance that lactating mothers and their babies find in the United States today. The right of women to breastfeed their babies was not contested at all during their time—there was no other viable option. My guess is that it would have been hard for them to imagine that in less than a century after their deaths, mothers who chose to nurse their babies instead of feeding them manufactured formulas would meet with so many externally imposed obstacles.

The goals set by Stanton, Truth, and Anthony that were achieved during the twentieth-century long after their deaths were audacious. Because of these pioneers and the activists who followed them, women can now own property; divorce an abusive husband; vote; be elected to public office; be professors, executives, or astronauts; fly planes; and wear clothes that would have shocked everyone who lived in the nineteenth century (when women’s ankles weren’t supposed to be seen). All of these are solid and necessary gains, but today, even in states whose laws declare that breastfeeding cannot be considered “indecent exposure,” the harassment of mothers for breastfeeding their babies when they leave their homes continues to a degree that is simply unacceptable. This rudeness to strangers and their babies can and must be stopped. In the nineteenth century, most U.S. mothers—if their health was good—nursed their babies, and people took it for granted that this elemental, nurturing act would have to take place as women traveled. I think it would have been hard for people in the nineteenth century to anticipate that advertising and marketing campaigns by infant-formula companies would become the dominant factor in parents’ decisions about infant feeding and that infant-formula companies could so easily convince the medical profession to become the first promoters of their products.

With all of the problems women faced in the mid-nineteenth century, it wasn’t necessary then to prove to the medical community and the general public that human milk was safe for human babies to drink. A century later, this was exactly what needed to happen. It was recognition of this necessity that led to the founding of La Leche League in the Chicago area in 1956. In large part, the influence of this organization prompted the research that persuaded the U.S. medical community that human milk is a safe food for human babies. Persuading the medical and nursing professions that it is a superior food is work that remains to us in the twenty-first century. Other essential work that must be done is the training of all health workers in how to care for women in ways that enhance, not undermine, their ability to breastfeed.

Stopping the promotion of artificial infant formulas in the United States (and the rest of the world) is just as necessary. Every one of the hospitals and birth centers in the United States in which babies are born should be Baby-Friendly—not a mere seventy-nine, nearly one-third of which are in California. We could be doing much better than this; several countries with far smaller populations than ours have many more Baby-Friendly hospitals per capita than we do. Consider the Philippines’s 1,427; Brazil’s 137; Thailand’s 780, Mexico’s 692, and tiny Ecuador’s 141. Nigeria’s 1,147, Iran’s 376, Turkey’s 83, Tunisia’s 141, Malay sia’s 144, and Egypt’s 122, all have us beat. Norway, with one-sixtieth of our population, has thirty-five Baby-Friendly hospitals. Sweden, with approximately one-ninth of our population, has sixty-four. Forty-nine of Cuba’s fifty-six hospitals are Baby-Friendly. Because these Baby-Friendly hospitals block the promotional schemes that the artificial-milk companies use to boost their profits, millions more babies now have a chance to be nourished on their mothers’ milk than before the Baby-Friendly Hospital Initiative was launched. If we work hard and organize well enough to stop all kinds of advertising and promotion of these products in the United States, breastfeeding can become possible for millions more mothers here as well.

It’s not that we haven’t had our own activists and friends in the public-health community in the United States working diligently to increase rates of breastfeeding; it’s that we have allowed a health-care industry responsible only to corporate boards of directors and stockholders to take the place of what should be a health-care system designed for the benefit of all of our people. A profit-driven health-care industry has no reason to care about increasing breastfeeding rates (or doing anything else to promote health, for that matter), as doing so will do nothing to boost anyone’s profits. I consider it a national embarrassment that our Department of Health and Human Services (DHHS) has never been able to collect solidly accurate statistics on breastfeeding rates for the first year of our babies’ lives through any of its agencies. In fact, it is an infant-milk corporation whose data on breastfeeding rates, gathered in 1989 and again in 1995 by surveying a sample of mothers at hospital discharge and again at six months, are considered more dependable than any data-gathering our government services have ever attempted. There is something profoundly wrong with this.

The Department of Health and Human Services is given the power to set goals but not the power to achieve them. We have to change this.

What Can Happen When There Is No Accountability

Millions of Chinese parents found out the hard way in September 2008 that it’s not a good idea to trust everything that comes in pretty packages from corporations, with the government’s seal of approval on them. That’s when the news finally reached the public that more than twenty-two Chinese infant-formula companies had been selling products adulterated with an industrial chemical called melamine, which can cause kidney stones or kidney failure. When blended into food, melamine (a crystalline white substance used in the manufacture of many plastics, fire retardants, and fertilizers) can make milk appear to have a higher protein content than it actually does; this helps watered-down milk pass quality tests in order to increase profits. At least six babies died, and another 300,000 were hospitalized with various manifestations of severe kidney disease. Anyone who has ever had a kidney stone knows how painful this disease is. Imagine having one when you’re two months old. This is the same chemical that was implicated in the toxic-pet-food scandal of 2007 that killed thousands of people’s pets all over the world.

Despite China’s large number of Baby-Friendly hospitals (reportedly more than 6,000), artificial-milk products have been aggressively promoted as China races to catch up with the industrialized nations of the world—in everything profitable, that is, but not in regulation. Many rural women leave their babies in the care of the grandparents so they can work in the cities. Many others have pursued careers that make breastfeeding difficult or have had breast augmentation that interferes with their ability to breastfeed. Even farmers’ wives who breastfed their babies during their first year of life have been convinced by aggressive advertising campaigns to wean earlier than their mothers would have and to introduce a formula-milk product as a staple. Many babies had been fed nothing but the poisoned milk formula from birth, with the result that babies a few months old had large kidney stones. A major reason for this public-health tragedy was that the Chinese government made the decision to stop product inspection for the twenty-two companies, since they had such exemplary records when they were still being regulated. Another big reason behind the public-health catastrophe is that China made the mistake of imitating U.S. health-industry fashions rather than following the lead of a country such as Norway, where women can have careers, be feminists, and still give their children the best start in life by breastfeeding them if possible.

Positive Steps Toward a Better Future

Believe it or not, Hollywood has begun to help the cause of promoting breastfeeding by making films that show women nursing their babies. In real life, it has become fashionable for celebrities to be seen in public while pregnant and to let it be known they will breastfeed their babies. This is huge. We need tons more of this to make up for the devaluing of breastfeeding that has gone on for so many years. Women desperately need to see other women nursing their babies. Children everywhere should see babies being nurtured at their mother’s breast. People who are afraid of allowing their children to know what breasts are for must clean up their minds.

We humans have to grow up and face the fact that our newborns’ nervous systems are programmed in every way imaginable to be attracted to breasts. As newborns, it’s what we most want to see, touch, smell, and taste. Even our sense of hearing leads us to the breast, since it is located so near our mother’s beating heart, our place of security. Let’s stop denying this, and we’ll be moving in the direction of greater sanity.

How about a reality program on television that shows expert mothers (let the lactation consultants screen for the experts) nurturing their babies? Some of the mothers would be nursing their babies, and others (who perhaps weren’t able to for some reason) would demonstrate how a baby should be held close to the breast while being bottle-fed. Surely Link TV could be persuaded to devote some airtime to this necessary educational service, provided that enough donations come in from viewers who request such programming. The kind of reality television that I’m talking about would not emphasize how to cover up properly while breastfeeding in public, as that would defeat the purpose of the show. We must see breasts and nipples wholesomely—not in a furtive way, but naturally.

Mother’s milk is soul food for babies. The babies of the world need a lot more soul food.


To the many people who helped me in the making of this book, I give my heartfelt thanks.

My grandmother Ina May Beard Stinson, who taught me to follow the example of women such as Elizabeth Cady Stanton, Susan B. Anthony, Helen Keller, and Jane Addams. They dreamed large, and she wanted me to know the challenges they overcame and how long it can take for change to come.

My parents, Ruth and Talford Middleton, who raised me to know that my body had the capacity to function perfectly—even if other people didn’t think that possible. What a priceless gift that has been throughout my life!

My aunt Myra Middleton Savage, whose lessons about the needs of female mammals provided me with a firm grounding in nature’s laws of birth and nurturing. These lessons proved invaluable when I began assisting women giving birth and nursing their babies.

My high school biology teacher, Leonard Cole, who taught me to keep an open mind, to question authority, and to look behind widely held assumptions that might later prove false.

My firstborn, Sydney Jane Kelley, for making my first breastfeeding experience easy and joyful—despite the hospital routines that kept us apart for most of her first five days of life.

My Malaysian (later Canadian) friend, Janice Ang, who in 1964 made me look at the negative effect that artificial milk feeding had on Chinese-Malaysian shopkeepers’ babies and the irony that the more expensive form of infant feeding was far less healthy than breastfeeding would have been. She was the first person to open my eyes to the public health problems posed by the marketing of artificial milk substitutes in countries where safe substitutes are hard or impossible to ensure.

The women who gave birth on The Farm during the 1970s, who taught me how well women can breastfeed when newborns have the necessary access to their mothers just after birth.

Shunryu Suzuki Roshi, extraordinary teacher of Zen practice and author of Zen Mind, Beginner’s Mind, who taught my husband, Stephen Gaskin, and by extension the people of The Farm community, that approaching problem solving with “beginner’s mind” can be a good thing.

Stephen Gaskin, my husband, for attracting the people who followed the least sexist aspects of the counterculture of the 1960s to live in community with us. His support and patience throughout the writing of this book made my work on it as fun as it could possibly be.

The men who lived on The Farm from its beginnings to this day, who taught everyone in our community that even men who aren’t used to public breastfeeding can accommodate to it and be healed in the process.

Eva, Samuel, and Paul, my children, for their love, their patience with my shortcomings as a parent, and the inspiration they have given me.

Asa Dotzler, who taught me how well newborns can crawl to the breast.

Margaret Nofziger and Louise Hagler, who taught me that some mothers have special needs and how to fill them.

Tisha Graham, whose generosity, breastfeeding expertise, and editorial skills helped me through difficult times during my writing process.

Eleanor Graf, lactation consultant, whose gentle words and teaching manner have transformed countless new mothers’ breastfeeding problems into breastfeeding success.

Bonnie Reed, lactation consultant, whose reading of various parts of the manuscript and whose expertise about breast pumps was voluminous and helpful.

Gayla Groom, for her sympathetic ear and wise counsel when I struggled with the writing.

My midwives, for protecting me and my last three babies so beautifully during the magic time after their births.

Mary Kroeger, midwife, international maternal and child health consul tant, whose untimely death from cervical cancer in 2004 followed the publication of her book Impact of Birthing Practices on Breastfeeding by only a few months. Ever the champion for women and babies whether she was working in any one of several African countries, Cambodia, Laos, Kazakhstan, Guatemala, Belize, or the United States, Mary made me promise to write this book: “Parents need the message as much as professionals do—that birth practices have a powerful impact on women’s ability to breastfeed and that lactation knowledge is part of the essential body of knowledge that should be studied by all midwives, nurses, and physicians involved in birth and baby care.”

Robyn Thompson, Aussie midwife and lactation consultant, whose generosity in inviting me along on several of her home lactation visits showed me how one-position-fits-all lactation advice given during short hospital stays can backfire on mothers who lack good follow-up lactation help such as that which she provides.

Suzanne Colson, research midwife, whose groundbreaking studies of lactation initiation have shown why mothers and babies need uninterrupted time with each other immediately after birth so they can do what should happen naturally.

Tina Greve, Norwegian midwife and lactation expert, who was always there to answer my questions about how Norway got so far ahead of North America when it comes to breastfeeding.

Juliana van Olphen-Fehr, midwife and midwifery educator, whose friendship, wisdom, and stories have nourished me at our every contact.

To Elizabeth and Ron Maxen, Jeanne and Leigh Kahan, David Frohman, Bernice Davidson, Kim Trainor, Angel Maharaj, Adanta Qubeck, Alison Blenkinsop, Alexandra Luzzatto, Allen Hagler, Anushka Bogoyevac, Bohdana Fasani, Catie Mehl, Andie Wyrick, Elizabeth Cochran, Janice Kahalley, Jenna Robertson, Jessica Coburn, Jennifer Moore, Julie Turner, Karen Strange, Natalie Carter, Kathryn Guernsey, Katie Riley, Kenda Burke, Neal Stiffelman, Virginia Gleser, Laura Hagler, Laura Lee, Laura Thompson, Leah Tarlen, Laureli Morrow, Linda J. Smith, Maddy Oden, Maja Vaskova, Mary Korduner, Nile Nash, Padraicin Ni Mhurchu, Pamela Hunt, Regi Kovaleski, Rosalie Kellman, Margaret

Wilmeth, Shannon Brinkman, Sherry Gaskin, Stacy Fine, Stefanie Rinza, Kenda Burke, Terry Barto, Tony Nenninger, Lorrie Leigh, Roberta Kachinsky, Leela Pratt, Árdis Kjartansdottir, Allison Gray, Leah Deragon, and all those who contributed ideas and stories.

To all those whom I may have unintentionally left off this list, please accept my thanks.