After overcoming the many barriers to breastfeeding in the early weeks and months of breastfeeding, many women are understandably proud to continue nursing into toddlerhood and beyond.*
But instead of a fist bump and words of encouragement, some moms instead find themselves on the defensive with their health care providers.
While there are countless supportive providers who share words of encouragement, we too often hear stories from moms in which their providers say:
“He’ll never learn to eat solid foods.”
“You don’t want to end up like one of those moms, do you?”
“Your milk has no nutritional value past a year.”
“Continuing to breastfeed is going to cause an unhealthy dependence in your child.”
“When are you going to stop?”
In Breastfeeding Older Children, author Ann Sinnott shares many of these stories. She quotes one mother as reporting, “even a fairly progressive pediatrician tried to shame my son into giving it up at the age of three.” Sometimes it’s even implied that mothers are only doing this “for themselves.”
Mothers’ fear about talking with their providers about sustained breastfeeding isn’t unfounded. In an American Academy of Pediatrics survey of members who wanted to improve their breastfeeding office support (and so might be considered supportive of breastfeeding) fully 25% of participants discouraged breastfeeding after 2 years.
In another study of health care providers attitudes (which included a large number of medical students) only 61% of respondents agreed with the statement “I think that it is acceptable for 1 or 2 year old children to be breastfed by their mothers.” That number dropped to 22% for children 3 to 4 years of age. 35% of respondents said that they would encourage a woman breastfeeding her 1 to 2 year old to wean, and 65% said they’d encourage a woman breastfeeding her 3-4 year old to wean. 35% of respondents agreed with the statement, “In general, I think breastfeeding a child of 3 years or older could cause psychological damage to the child.”
The fear of judgement or discouragement is strong enough that one paper on the topic (unpublished) by Kathleen Kendall Tackett and Muriel Sugarman is entitled “Don’t Ask, Don’t Tell: What Women Say to Doctors about Extended Breastfeeding.” In it, the authors note that “previous studies have found that women who continue to breastfeed frequently do so in secret, a phenomenon described in the literature as ‘closet nursing.’ Women and doctors participate in a conspiracy of silence.”
The authors tell the story of one mother whose fear of judgement led to adverse health consequences for her child:
Stephen D. (age 21 months) was seen by his doctor because of severe diarrhea and vomiting. The mother was quite concerned and made repeated office visits and telephone calls. The doctor did not initiate treatment because Stephen was not dehydrated and was not losing weight. The doctor did not realize, however, that Stephen was breastfeeding approximately six times per day and at least two to three times at night. After 17 days of daily vomiting and diarrhea, Stephen’s doctor prescribed Flagyl. The symptoms lessened within 24 hours, and were gone within 48 hours. Stephen’s mother never told the doctor that Stephen was still breastfeeding because she feared that the doctor would be critical. Stephen’s mother was an active and outspoken proponent of breastfeeding, yet in this situation, even she felt she could not reveal that she was still nursing. In retrospect, she feels that the doctor not knowing this information may have delayed treatment.
Psychologists are particularly undone by the idea of sustained breastfeeding, says Sinnott. Of psychologists in the UK she says:
Sustained breastfeeding runs so counter to the training of psychologists that it was difficult to get most of the UK psychologists with whom I spoke to countenance even the mere notion that long-term breastfeeding could be anything other than pathologic… All of the psychologists I spoke to were surprised and sounded distinctly worried to hear that large numbers of children are currently breastfed in the developed world.
What’s the source of this discomfort?
Many of our providers don’t know much about sustained breastfeeding, and as a result view it as potentially harmful in a variety of ways. This isn’t too surprising, since providers’ knowledge of breastfeeding even in the early months leaves a lot to be desired. And since sustained breastfeeding is less common, and some is ‘closeted’ for fear of judgement, providers may be further thrown off when they encounter it. (In this sense, are we complicit in the “conspiracy of silence?”)
It also results from the prevalent view of breastfeeding as solely, or primarily, nutritional and immunological in purpose, and discomfort with the idea of breastfeeding as a normal part of psychological development. Fear of creating an “unhealthy dependence,” can lead mothers to be discouraged from comforting or connecting with their children through breastfeeding past infancy. Our providers are also subject to the same cultural messages we are about the the breast as sexual object, and can become concerned about nursing past infancy as somehow sexual in nature.
Are we expecting too much of our providers? In Mothering Your Nursing Toddler, author Norma Jane Bumgarner writes, “Doctors and nurses are trained in identifying and treating illness. It is not fair to them to expect them to also be experts in all aspects of child care and family living… Their advice on child care tends to be no better and no worse than that of other reasonably well-informed adults. That is as it should be, and it is a mistake to expect more.”
That would be fine if, at a minimum, our providers treated our choice to breastfeed long-term as they would treat our choice of diaper bag – an individual choice. But repeated reports from moms and studies of provider attitudes suggest that their response is often far from it.
“Long-term breastfeeding is a growing phenomenon (in developed countries) and healthcare providers are lagging behind,” says Sinnott:
Health providers must overcome personal and cultural prejudice and inform themselves… It is imperative that health professionals acknowledge that their certainties are founded on nothing more than myth and received opinion, and understand that sustained breastfeeding has been integral to our species for 95% of all human existence, and is today still a normal practice in much of the world.
*In the absence of a perfect phrase, we refer to breastfeeding past infancy as “sustained breastfeeding” (as used in Breastfeeding Older Children) in this post. It’s our wish that someday it will be known simply as “breastfeeding.”
Did you breastfeed into toddlerhood or beyond? How did your health care providers react to your choice? Did you feel uncomfortable telling your providers?