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From Living Rooms to Hospitals: The Breastfeeding Movement and the Limits of Success
Jessica Martucci
“At this point I’m about 33 days into breastfeeding and I have to say that I really want to quit. It’s so much harder than I thought it was gonna be.” So lamented Michaeleen Doucleff, an NPR reporter, whose segment on the “lost instinct” of breastfeeding played on the station’s Morning Edition show in the summer of 2017.[1] Doucleff’s piece paired her brief self-recorded and tearful confession from the early days of her child’s life with an academic listing of breastfeeding difficulties, ranging from pain and low milk supply to sheer and utter exhaustion. Her experience with breastfeeding exemplifies the stories of many twenty-first-century women who struggle to meet current infant feeding recommendations of the American Academy of Pediatrics.[2]
Given the ubiquity of the medical and public health mantra that “breast is best,” it’s easy to forget how recent this push for breastfeeding really is. Until the 1970s breastfeeding initiation rates in the United States had been in steady decline for nearly a century, falling to close to 20%.[3] By the postwar years, most physicians favored formula feeding and women regularly received lactation suppressants without their knowledge. Today, however, mothers endlessly hear about the benefits of breastfeeding and four out of five them decide to give it a try.[4] How can we account for this rapid turnaround?
The answer is rooted in the emergence of an incredibly successful grassroots health movement that began in the living rooms of white, middle-class suburban housewives in 1950s America.[5] These postwar moms began connecting their personal, embodied experiences as mothers to a shared cultural and social identity that they used to push for change in the delivery of maternal healthcare, and they did so over a decade before the feminist Boston Women’s Health Book Collective formed.[6] Their legacy is visible in breastfeeding rates today of over 80%, but it is equally present in the heart-wrenching stories of mothers who struggle through pain, fatigue, depression, and other hardships to meet these heightened demands for motherhood. Embedded in the history of the move back to the breast, then, is a story about what is gained and what is lost on the road to changing medical practices and policies.
Grassroots Beginnings
The early breastfeeding movement had its most substantial organizational home in La Leche League (LLL), a breastfeeding support group formed by seven Catholic mothers in the suburbs of Chicago in 1956.[7] Although La Leche wasn’t the only group to provide breastfeeding information and support, it was the first of its kind with the explicit mission to support mothers who wanted to breastfeed. Armed with as much scientific and medical information as they could gather, the founders of the group read and exchanged information, shared personal experiences, and made suggestions based on this to other breastfeeding women they encountered. The group fulfilled a growing need in the postwar decades, and by 1980 it had grown to an international force with over 12,450 active League leaders and over 4,370 local groups.[8]
The core of La Leche League was the weekly support meeting. These groups offered information and expertise that few, if any, hospitals or healthcare professionals at the time could. As word about these groups spread, women flocked to them in growing numbers throughout the 1950s, 1960s, and 1970s. The meetings welcomed breastfeeding infants and children, of course, and offered mothers a chance to share breastfeeding tips, troubles, and anecdotes about their experiences. For those used to living within the confines of the postwar era’s strict gender and sexuality codes, just being in the company of other breastfeeding mothers could be an eye-opening experience. As breastfeeding research pioneer Niles Newton recalled of her first visit to a League meeting, “there were nine breast fed babies at that meeting and many of them got discretely nursed. For the first time in my many years of breast feeding four children I didn’t feel odd—I felt I was in a group where breast feeding was natural, the customary thing to do.”[9] Through these intimate gatherings mothers not only shared and developed expertise and tacit knowledge about breastfeeding as their infants grew from newborns to toddlers, they also built a community of friendship, support, and a sense of shared identity in their embrace of an embodied and “natural” motherhood.[10]
Despite their narrow focus on breastfeeding, the growth of these groups also helped to cultivate and spread interests in other aspects of the maternal experience. Group meetings covered everything from sleeping troubles to methods for discrete public nursing and baby slings. Natural childbirth and infant rooming-in practices were of particular interest because early research suggested that diminished medical interventions during and after birth could help promote breastfeeding success when compared with standard hospital procedures. As the organization grew, their beliefs in the superiority of these “natural” maternal processes set them radically apart from the era’s mainstream medical practices surrounding childbirth and infant care. Mothers in this period labored in hospitals without the comfort of friends or family, often under heavy anesthesia drugs. After delivery, they experienced prolonged periods of separation from their infants, who were kept in newborn nurseries and tended by nurses. As more and more mothers began expressing an interest in breastfeeding, however, they helped place mounting pressures on hospitals, doctors, and nurses to change their policies and practices to better support breastfeeding.
Building Healthcare Allies
The local meeting structure of La Leche League allowed for geographical variation, but it also kept the groups linked to a central source for standardized health information and advice. The grassroots aspect of the groups also meant that highly localized knowledge about breastfeeding-friendly doctors, nurses, and hospitals could be built up and exchanged. From the beginning, local groups took it upon themselves to cultivate relationships with potential allies in their local healthcare systems, visiting hospitals and doctors to pass out pamphlets about how mothers could get in touch with the group. In this way, local LLL groups reached into the health systems in communities across the country, influencing the practices and attitudes of healthcare providers in the places where they were active.
While having a doctor’s support was helpful, La Leche League learned early on that there was no better or more important friend to have in the weeks or days spent recovering from birth in the hospital than one’s nurse. La Leche League did maintain a medical advisory board made up of leading experts in pediatrics and reproductive medicine, but the medical profession was difficult to reach in a systematic way. And although they became certified to offer continuing medical education credits in 1974 and hosted an annual physician’s conference for years, it was not until 1994 that the American Academy of Pediatrics joined them to cosponsor the event.[11] Nurses, however, were in many ways a more critical target for the breastfeeding movement. From the beginning, La Leche League recognized the important role that nurses had to play in the effort to improve breastfeeding success for new mothers. In the context of the nursery and maternity floors, nurses held a considerable amount of power over the experiences of mothers and their newborns in the days and weeks following birth. Nurses could support breastfeeding, be ambivalent, or be actively opposed to it. As gatekeepers between a mother and her infant, nurses determined whether infants received bottles of formula or sugar water when they cried in the nursery. Nurses could help a mother through her first breastfeeding sessions, or they could be cold, rough, and unfeeling.
In response to these realities, La Leche League’s tome The Womanly Art of Breastfeeding, first published in 1958, included a section on how mothers should try to cultivate a positive relationship with the nursing staff to get them on their side. They encouraged mothers to “casually mention to the nurse that you’re glad your baby isn’t getting any formula—since you’ll be completely breastfeeding him.” They also urged mothers to get their physicians to note in their orders that the nurses should bring the baby to its mother for feeding “at least every three hours” and “for at least one night feeding.”[12] Overall, however, La Leche League acknowledged that the hospital routine, coupled with the lack of breastfeeding training or interest in most nurses, was an inevitable stumbling block for most mothers on their path to breastfeeding success.[13]
For their part, many nurses came to sympathize with the breastfeeding movement and worked at the frontlines to slowly change the culture that surrounded postpartum and nursery care. Nursing leaders in postpartum care like Kate O. Hyder and Betty Ann Countryman saw in breastfeeding an opportunity to cultivate a new area of nursing leadership and expertise. La Leche League jumped at the opportunity to build stronger relationships with the nursing profession. Some nurses found out about breastfeeding by attending La Leche League meetings when they became mothers, while others learned about the groups from their encounters with well-prepared breastfeeding mothers in the hospital. Connections between nurses and the breastfeeding movement grew slowly but surely throughout the 1960s and 1970s. One nurse, Josephine Iorio from Jersey City, New Jersey, wrote about her support for La Leche League in the field’s flagship journal the American Journal of Nursing: “I give new mothers the names of La Leche members so that, if at home they have any problems or questions, they can call for help.” She also encouraged her colleagues to get more involved, adding “meetings are open to nurses and those of us who have attended have learned better how to help patients.”[14]
Forging a New Profession
By 1972 La Leche League had built up enough of a network among nurses that they brought together a group of maternity nurses to author a pamphlet specifically to encourage and support their colleagues working with breastfeeding mothers. Despite these inroads, however, many nurses maintained a persistent belief in the parity of bottle feeding vs. breastfeeding and found it difficult to empathize with breastfeeding mothers who they often saw as “disruptive of hospital routines,” overly “demanding,” and even fanatical.[15] Unable to turn to either physicians or nurses as committed healthcare supporters for breastfeeding, the movement turned to the possibility of formalizing the services that its seasoned La Leche League leaders had been providing for decades. As group leaders in the League, mothers had to demonstrate considerable personal experience and know-how to run their local branches. LLL required that its leaders had breastfed their own child exclusively for at least one year. This kind of tested expertise was rare if not impossible to find in most healthcare providers, and as the breastfeeding rate climbed throughout the 1970s, demand for breastfeeding support grew rapidly. In response, La Leche League began taking the first steps towards the creation of a new kind of healthcare professional when it created its Lactation Consultant Department in 1982. Over the next few years the leadership from this department, Linda J. Smith and JoAnne Scott, researched the process of forming a new profession. In 1985, 196 practicing lactation consultants gathered at the first official meeting of the International Lactation Consultant Association (ILCA) in Washington, D.C. That same year, La Leche League also helped launch the International Board of Lactation Consultant Examiners, now the official credentialing organization for International Board-Certified Lactation Consultants (IBCLCs). Of the 259 people who took the very first IBLCE examination, 133 were La Leche League leaders and 93 were registered nurses.[16] Once lactation consultants took this step, the forces that worked to shape the nature of breastfeeding support moved beyond the hands of the La Leche League, nurses and the movement of mothers.
Success and Its Limits
In 1979 La Leche League International participated in the WHO/UNICEF Meeting on Infant and Young Child Feeding in Geneva, Switzerland. The meeting served as the opening of a new era of global health’s focus on breastfeeding. Since then, La Leche League has maintained a key position not only in U.S. policies surrounding breastfeeding, but global policies as well. In 1981 they became a UNICEF affiliate, and in 1993 the WHO granted them “official relations,” allowing them non-state actor status in the international health organization. In 1991 the WHO and UNICEF launched the Baby Friendly Hospital Initiative in an effort to continue supporting breastfeeding, adopting many of the ideas about institutional change that La Leche League had espoused for decades.[17] The levels of success enjoyed by the breastfeeding movement are staggering and have undoubtedly helped millions of mothers and babies since it first took off in the 1950s. At the same time it’s important to note how these policy changes, institutional shifts, and the emergence of professional lactation consultants have contributed to an increasingly high-pressure environment for mothers without the benefit of the warm and supportive living rooms that first nurtured the movement’s foremothers.
Far more mothers today have access to expert knowledge about breastfeeding than they did in the 1980s, a change that has helped fuel the continued rise in the rates of breastfeeding initiation to over 80%.[18] Detached from the networks of support and community that fostered it, however, the breastfeeding movement’s distillation of its efforts into the professionalized role of the lactation consultant has had its costs. Among these have been the loss of the comradery and prolonged exposure to breastfeeding knowledge and support. When those postwar mothers gathered in living rooms to share their experiences, offer friendship, and commiserate when needed, they reconstructed a modern form of the female knowledge networks that had historically shaped women’s childbirth and postpartum experiences.[19] Disentangled from these communities built around embodied female knowledge, breastfeeding expertise has arguably become more accessible while it has also become the purview of “strangers at the bedside.”[20] Mothers today can of course still seek out additional forms of support on their own by attending a meeting of La Leche League or reaching out to a nursing mothers’ group online. The professionalization of lactation expertise and the institutionalization of the breastfeeding movement, however, have left an indelible and unmistakable mark on the experiences and expectations of twenty-first-century mothers.
Author
JESSICA MARTUCCI is a postdoctoral fellow in advanced biomedical ethics at the University of Pennsylvania and a research fellow at the Center for Oral History at the Chemical Heritage Foundation, Philadelphia, PA. She is the author of Back to the Breast: Natural Motherhood and Breastfeeding in America (University of Chicago, 2015).
Notes
[1] Michaeleen Doucleff, “Secrets of Breastfeeding from Global Moms in the Know,” Morning Edition on National Public Radio, June 24.
[2] The AAP recommends “exclusive breastfeeding for about 6 months, followed by continued breastfeeding as complementary foods are introduced, with continuation of breastfeeding for 1 year or longer as mutually desired by mother and infant.” See Arthur I. Eidelman and Richard J. Schanler, “American Academy of Pediatrics, Policy Statement: Breastfeeding and the Use of Human Milk,” Pediatrics, 129 (March 2012), e827–41, esp. e827.
[3] U.S. Office of the Surgeon General, U.S. Centers for Disease Control and Prevention, and U.S. Office on Women's Health, The Surgeon General's Call to Action to Support Breastfeeding (2011).
[4] U.S. Centers for Disease Control and Prevention, “Breastfeeding Rates Continue to Rise in the U.S.,” August 22, 2016.
[5] There is growing historical work that highlights the postwar suburbs as a place where many American women learned to identify and connect with the politics of their everyday lives. See for example, Christopher C. Sellers, Crabgrass Crucible: Suburban Nature and the Rise of Environmentalism in Twentieth-Century America (2012).
[6] Jessica Martucci, “Why Breastfeeding? Natural Motherhood in Post-War America,” Journal of Women’s History, 27 (Summer 2015), 110–33.
[7] The original La Leche League (LLL) founders included Mary White, Edwina Hearn Froelich, Mary Ann Cahill, Betty Wagner Spandikow, and Viola Brennan Lennon.
[8] Graph of LLL Groups, folder 2: Statistics and Surveys, 1984–1988, box 9, Betty Wagner’s files, La Leche League International Records (DePaul University Library Special Collections).
[9] Niles Newton, “Breast Feeding Today,” presented at the National Convention for Childbirth Education at Milwaukee, Wisconsin, May 21, 1960, Niles Newton’s Correspondence Files, La Leche League International Records (DePaul University Library Special Collections).
[10] Jessica Martucci, Back to the Breast (2015), 3–5, 13–14, 143–45, 226–27.
[11] “A Brief History of La Leche League International,” La Leche League International; American Academy of Pediatrics Board of Directors Meeting, Oct. 20, 1994, folder—Work Group on Breastfeeding Board Action, box 361, (Pediatric History Center Collection, American Academy of Pediatrics).
[12] La Leche League, The Womanly Art of Breastfeeding (1963).
[13] Jessica Martucci, “Maternal Expectations: New Mothers, Nurses, and Breastfeeding,” Nursing History Review 20 (no. 1, 2012), 72–102.
[14] Martucci, Back to the Breast, 129.
[15] Ibid., 136.
[16] Ibid.,189–90.
[17] Launched in 1991 by the World Health Organization and UNICEF the Baby Friendly Hospital Initiative (BFHI) is a global health program that seeks to improve breastfeeding rates by encouraging hospitals to promote breastfeeding and seek the BFHI designation.
[18] U.S. Centers for Disease Control and Prevention, “Breastfeeding Rates.”
[19] Judith Walzer Leavitt, Brought to Bed: Childbearing in America, 1750–1950 (Oxford University Press, 2017).
[20] Reference is to the work of David J. Rothman, Strangers at the Bedside: A History of How Law and Bioethics Transformed Medical Decision Making (1991).
