Booby Traps Series: “Las dos” and other cultural barriers to breastfeeding

las dos 4A while back I wrote about cultural Booby Traps in the hospital, and offered my own embarrassing story of how, in trying to help a mom, I found myself creating a Booby Trap for a mom.

But the flip side of providers not knowing how to deal sensitively with moms’ cultural practices that don’t affect breastfeeding success, are some cultural practices that do undermine breastfeeding.  So in this post I’m discussing some of the cultural Booby Traps we inherit or absorb from our communities.

Some cultural practices moms follow are helpful when it comes to breastfeeding, some are harmless, and some are harmful, and it’s important to understand the difference.

Some helpful or harmless cultural practices are things like eating special foods.  Moms of Mexican heritage sometimes says they need to drink atole.  Some moms of Chinese background say that they need to balance “hot and cold” foods while breastfeeding.  These are all things that are either helpful or harmless.

You might think that moms would feel constrained by being told that they need to eat certain traditional foods, and that this would hinder breastfeeding.  But consider the example of this hospital, which discovered that for Cambodian American moms “one barrier to breastfeeding is a lack of hospital foods that allow women to follow a traditional diet postpartum.”  The childbirth unit and the food service department teamed up to offer a traditional Cambodian menu for moms, and the rate of breastfeeding increased from 17% to 67%.

These kinds of traditions are comforting and make us feel that things are “right.”  Think turkey at Thanksgiving, birthday cakes at birthday parties, even popcorn on movie night.

spanish_natures_secret_give_only_the_breast

But when it comes to other practices which do undermine breastfeeding and exclusive breastfeeding, we sometimes find themselves Booby Trapped by our own cultures.  And in those instances providers do have a responsibility to discuss it and make sure moms understand the implications.

An example of a cultural practice which does undermine breastfeeding is “las dos” or “las dos cosas.”  “Las dos,” which means “both,” is an expression used by some Latina/Hispanic moms to describe feeding by both breastfeeding and formula.

This practice is significant enough that it shows up in national breastfeeding rates.  While Latinas initiate breastfeeding in numbers higher than the U.S. average (80% compared to about 75%), they also supplement more than the average (at two days, 33% compared to 25%).

There are a number of reasons why Latinas plan to do “las dos,” including some common to all moms (return to work or school, discomfort with nursing in public) and some which are more specific to the mothers’ culture, such as a high value placed on very chubby babies, the belief that breastmilk lacks vitamins, and the belief that negative emotions can spoil breastmilk.

But the problem with doing “las dos” is that it deprives the baby of the benefits of exclusive breastfeeding, and it creates problems with the mother’s milk supply.  Some mothers don’t understand that supplementing can cause these problems.

That’s why in 2010 the Massachusetts Breastfeeding Coalition created a poster campaign to address this issue, based on research and focus group discussions with Latina moms about “las dos.”  The posters explain that “las dos” can harm milk supply.  In one case it talks about “the secret” to keeping milk flowing (this was the way Latina moms we interviewed talked about it) is to “give only the breast.”  And one used humor to get the message across – a slogan actually coined by my husband!

Another cultural Booby Traps is the “colostrum taboo- ” a belief that colostrum is bad, “stale,” or even evil.  This leads mothers to express and discard their colostrum and feel their babies formula until their mature milk comes in.

This is an ancient belief, and common to many cultures.  It was once prevalent in Ireland and the U.K., and remains a belief in some African and Indian cultures (here is my favorite PSA related to it, from India).  I saw this practice among Russian moms at a hospital where I worked.  Obviously, this practice means that the babies do not receive the immune-rich colostrum, are exposed to formula very early, and may impact the speed at which mothers’ mature milk comes in.

Let’s also acknowledge that cultural beliefs that undermine breastfeeding aren’t just held by recent immigrants.  Remember that in mainstream American notion that feeding on cue will “spoil the baby,” creating too much dependency.  The practice of scheduling feedings, formerly endorsed by pediatricians, is one cultural practice that has a significant effect on breastfeeding by hindering the development of moms’ milk supplies and reducing the amount of milk babies get.  This idea may be well on its way out, but it was prevalent for quite a while.  If you don’t ascribe to it yourself chances are your mom or grandmother did.

So there are many ways in which our cultural practices are helpful or harmless, and other ways in which they do us a disservice when it comes to breastfeeding.  It’s important to know the difference.

Did you follow a cultural practice that helped or hurt your breastfeeding experience?  Have you helped moms who followed these practices? 



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