Feeding bouts and nipple shields (heading into battle or feeding a baby?)

Breastfeeding conjures images of a mother and a baby, skin-to-skin, unfettered by technology. Many people believe that breastfeeding is instinctual, second nature, effortless. In reality, breastfeeding is a skill that humans, like other primates, acquire through social learning (Volk 2009). It takes practice, patience, and often involves a team of supporters and sometimes technology (think: breast pumps, bottles, artificial nipples, tubes, syringes, spoons, cups, and more).

 Lactation technologies have been a part of human breastfeeding practices for at least 2,500 years.

But when did we start talking about breastfeeding as if it was akin to playing a full contact sport? (Like when a feed at the breast is called a “bout.”) And, why are some lactation technologies referred to as body armor? You know, nipple shields, breast shells, and breast pumps called the DEFENDER. 

Are we talking about going into battle here or nursing a baby? How did the lactating breast become a combat zone between mothers and their babies?

I know that for many breastfeeding mothers, these military metaphors ring true to experience. “Bruised and battered” are, quite honestly, appropriate adjectives to describe what happens to nipples when problems arise. And these complications often do more to distance mothers from their nurslings than bring them closer together. A fear of pain is a common reason many mothers say they don’t want to breastfeed. Pain while breastfeeding is also one of the reasons that many mothers choose to stop breastfeeding or switch to pumping exclusively. I certainly don’t want to minimize the realities of breastfeeding difficulties. They can be devastating, especially for parents who really want breastfeeding to work.

But here, I’m more interested in exploring what’s behind the ways pain and antagonism are integrated into broader social ideas about and representations of breastfeeding. Are the experiences shaping these metaphors, or do the metaphors mold experiences?

Today, military metaphors are so deeply engrained in the way that we understand the body – and the world at large – that they pervade the way we talk about everything, even breastfeeding.

Exhibit A:  Behold the historic nipple shield!

I keep looking at these things wondering if they work. Like, I kind of want to get my hands on one and experiment. (Do you think the Wellcome Library would allow that?) The silicone nipple shields we use today are remarkably supple, and even then, many breastfeeding mother-baby dyads have trouble using them. Can you imagine trying to get a baby to latch, and stay latched, with one of these metal things in its mouth?!

These artifacts are pretty old. Just how long have mothers had need for safety gear in order to breastfeed?

In his well-researched, yet brief historical report titled, Guttus, tiralatte, and teterelle: a history of breast pumps, Obladen describes the use of early milk expression and feeding technologies from ancient times through the 20th century. Early nipple shields were used to address lactation issues in much the same way as we still use them today – to draw out inverted or elongate short nipples, heal nipple trauma, assist a baby with poor latch or weak suck.

Obladen notes how the rise of the corset was believed to cause an “epidemic of inverted nipples” in the 16th-18th centuries, an era in which we see the greatest innovation and diversification of the Western biomedical lactation toolkit. In 1791 Charles White wrote:

The small flat nipple which lies buried in the breast is generally occasioned by the tight dress, which has for some centuries been so constantly worn in this island by the female sex of all ages, and of almost all ranks. This dress, by constantly pressing upon the breast and nipple, reduces it to a flat form, instead of a conical one, with the nipple in its apex, which it ought to preserve. (In Obladen 2012: 671)

Many of these early nipple shields were used in conjunction with breast relievers, which were a pipe-like device that relied on suction from a person’s mouth (pictured below), or a hand- held pump.

According to Obladen, these tools served two main purposes. One was to draw out the nipple prior to latching a baby. Another would have been to stimulate a flow of milk, easing the process of breast milk expression in cases where excoriation of the nipple tissue made it difficult to breastfeed. Obladen notes a curious preoccupation with elongated nipples in these historical medical texts. For example, here is a description of how a clyster syringe, cupping glass, and piston pump were used before birth to prep the nipples and “open the milk ducts:”

My first concern is the frequently necessary elongation of the nipples, and the opening of the milk ducts. For this purpose I apply the tool already eight days before the expected delivery, twice or thrice daily…When the nipples withdrew too deeply into the breasts, I apply the small and flat recipient with the stopcock, pull out the nipple with the pump, close the syringe and leave the glass sitting on the breast from morning to evening. (Georg Wilhelm Stein, 1774, in Obladen (2012:671)

I read with great interest Obladen’s reports of early medical descriptions of nipple trauma and physicians’ concerns with preventing low milk supply if an infant could not feed at the breast. I was particularly intrigued by the teterelle bi-aspiratrice (bi-suction breast shield). This contraption relied on negative pressure to suction milk from the breast and direct its flow down a rubber tube attached to a dummy in the baby’s mouth; breast milk flowed directly from the breast to a nursing baby in arms!  These devices were used especially in cases where babies were born early or too sickly or sleepy to nurse efficiently at the breast.

(A nice online collection of these devices, along with other historic infant feeding paraphernalia, may be found here.)

Below, you can see clearly see that modern day mechanized breast pump flanges were based on the designs of these early nipple shields.

What have we learned from this quick walk through history? Well, for one, common breastfeeding issues, like soreness, pain and trouble getting a good latch, aren’t unique to 21st century breastfeeders. It is also evident that early lactation technologies were created to expand the possibilities for giving breast milk to an infant, so that they might have the best chance of survival. The major battle being fought when these devices were created was not between a breastfeeding mother and baby, but one between life and death.

In her captivating New Yorker piece entitled Baby Food, Jill Lepore writes about the breastfeeding crisis that ushered in the reign of normative formula feeding in the U.S.:

Then bizarrely, American women ran out of milk. “Every physician is becoming convinced that the number of mothers able to nurse their own children is decreasing,” one doctor wrote in 1887. Another reported that there was “something wrong with the mammary glands of the mothers in this country.”

The Industrial Revolution propelled American families to urban areas, and women increasingly gained employment beyond the domestic sphere. This period was marked by skyrocketing infant mortality rates as fewer and fewer babies were breastfed (Wolf 2001). The chasm between babies and breasts deepened as the sexualization of women’s bodies gained social currency (Blum 2000). Human milk banks and effective breast milk substitutes were created in direct response to the dramatic decline in breastfeeding (Swanson 2009).

This particular historical moment was punctuated by the transfer of authority over infant care in the U.S. from mothers and midwives to (mostly male) physicians, a transformation that Rima Apple describes as scientific motherhood. Many pediatricians began to treat formulas as interchangeable with, or superior to, breast milk, and parents (not all of them, but a lot of them) bought into this idea (Wolf 2001). When infant formulas hit the commercial markets, it quickly became a status symbol of wealth, health, and prosperity.

Medicalized theories of infant development and child rearing also became popular during this time. Parent were encouraged to nurture individualism and independence through practices that further distanced babies from breastfeeding, including separating mothers and babies at birth, putting babies alone in a nursery, and instructing parents to use cry-it-out sleep training practices (Tomori 2014). Breastfeeding really didn’t stand a chance under these circumstances, and well, the breast is history.

Ideologies and practices that pit babies in opposition to their caregivers are deeply entrenched in how we are socialized to care for infants in WEIRD (Western, Educated, Industrialized, Rich, Democratic) societies (Small 1999; DeLoache & Gottlieb 2000). Emily Martin (1995) attributes the militarization of the body, in the U.S. at least, to the rise of World War II and a political preoccupation with foreign invasion and defending national boundaries. Metaphors of self vs. other worked particularly well when describing early theories of human immunology that were established during this period. Perhaps not so coincidentally, separation of the symbiotic breastfeeding dyad into a discrete self and other, both figuratively and literally, was intrinsic to scientific mothering and formula feeding of this same era. It is here where these military representations of breastfeeding began to take root in both medicine and society.

Yet, these types of representations are not applied equally across all forms of infant care; in fact they seem to co-occur with ones that are specifically related to maternal and infant inter-embodiment. They have been used in representations of co-sleeping, where breastfeeding mothers who sleep with their babies are portrayed as a lethal weapon (Tomori 2014).

Hausman (2011) describes similar types of representations used to depict breastfeeding mothers as reservoirs of disease and pollutants. Likewise, Carter, Reyes-Foster, and Rogers (2015) have drawn attention to public critiques of breast milk sharing that have incorporated violent weaponized imagery.

We simply do not see the same proliferation of these metaphors in representations of formula or bottle feeding. Granted, formula feeding has become laden with its own baggage in the wake of breastfeeding promotion. Formula feeding parents deal with their own stigmas around not breastfeeding (Barston 2012). These issues are equally disconcerting and relevant, and they deserve critical attention.

Still I think it’s important to ask why breastfeeding continues to be represented as a battleground between mothers and babies when formula feeding is not, at least not to the same degree. Are differences in these representations accidental or by design? Who benefits from these types of representations and who loses?

An easy explanation is that big business has a lot to gain. Corporations have a very specific purpose – to create a market for whatever products they are peddling. In order to achieve this goal, they often need to also sell people ideas about things. What better way to do this is to capitalize on deeply seated anxieties that exist between mothers and babies – the fear of pain, shame, and failure –  and then provide timely solutions that are just a purchase away?

Companies that sell formula, bottles, nipples, and breast pumps have expertly maneuvered their way into the hearts and minds of breastfeeding America with their clever breastfeeding support rhetoric, all the while ensuring that ideas regarding the naturalness of mother and baby separation are still perpetuated. The blatant military metaphors may be cloaked, but the basic ideological foundation is there – Breastfeeding is bound to end in battle. When it does, we have the technology that leads to world peace, or as Similac puts it, the Sisterhood of Motherhood. These companies are not simply addressing a market demand, they are changing the conversation about breastfeeding in ways that make their products no only relevant but imperative.

The difference between lactation technologies of today and the guttus, tiralatte, and teterrelle of the past is that historically these technologies were always meant to preserve the breastfeeding relationship at all costs. Today, we are somehow left with technologies, including infant formulas, which are treated as intrinsic to breastfeeding as the inevitable disintegration of the breastfeeding dyad. It does seem that capitalism has a lot do to with creating metaphors that set up expectations, which affect experiences.

I will ponder these things  the next time I hook myself up to my super fancy, double-down, electronic, supersonic breast pump, full of thanks that at least I don’t have to suction my own breast through a glass cup using my mouth.

Do you know of other sites with great collections of historic lactation technology? Or better yet, any definitive works on the history of these technologies and associated medical theories  in biomedicine or non-Western biomedical systems? Please share!

References

Apple, R. Constructing mothers: scientific motherhood in the nineteenth and twentieth centuries. Social History of Medicine, 1995, 8: 161-178

Barston, S. Bottled Up: How the Way We Feed Babies Has Come to Define Motherhood, and Why It Shouldn’t, 2012, University of California Press

Blum, L.M. At the Breast: Ideologies of Breastfeeding and Contemporary Motherhood in the United States, 2000, Beacon Press

Carter, S.K., Reyes-Foster, B., and Rogers, T.L. Liquid-gold or Russian Roulette: milk sharing in the US  news media. Health, Risk, and Society, 2015, 17: 30-45

Hausman, B. Viral Mothers: Breastfeeding in the Age of HIV/AIDS, 2011, University of Michigan Press

DeLoache, J. & Gottlieb, A. A World of Babies: Imagined Childcare Gudies for Seven Societies, 2000, Cambridge University Press

Lepore., J. Baby food: if breast is best why are women bottling their milk? 2009 (January 19), The New Yorker

Martin, E. Flexible Bodies: The Role of Immunity in American Culture from the Days of Polio to the Age of AIDS, 1995, Beacon Press

Obladen, M. Guttus, tiralatte, and teterelle: a history of breast pumps. Journal of Perinatal Medicine, 2012, 40: 669-675

Small, M. Our Babies, Ourselves: How Biology and Culture Shape the Way we Parent, 1999, Anchor

Swanson, K. Human milk as technology and technologies of human milk: medical imaginings in the early 20th century United States. Women’s Studies Quarterly 2009, 37: 21-37

Tomori, C. Nighttime Breastfeeding: An American Cultural Dilemma. 2014, Berghann

Wolf, J. H. Don’t Kill Your Baby: Public Health and the Decline of Breastfeeding in the 19th and 20th Centuries, 2001, Ohio State University Press

Volk, A.A. Human breastfeeding is not automatic: why that’s so and what it means for human evolution. Journal of Social, Evolutionary, and Cultural Psychology, 2009, 3:305-314