Abjectly Boundless

Boundaries, Bodies and Health Work

Trudy Rudge, Dave Holmes

• Publisher: Routledge
• Year: 2016
• eBook ISBN: 9781317186151
• Edition: 1
• Topic: Social Sciences
• Subtopic: Anthropology
• Index: Social Sciences

Within a variety of practice environments, health professionals often experience feelings of disgust and repulsion towards the presence of an abject object. Cadaverous, sick, disabled bodies, troubled minds, wounds, vomit and so forth are all part of health and care work and threaten the clean and proper bodies of those who undertake it, yet this 'unclean' side of health work is rarely accounted for in academic literature. This volume employs the work of Julia Kristeva through a range of case studies drawn from care and nursing settings around the world. It brings together work from researchers and practitioners within the social and health sciences, the caring professions and psychotherapy, to expose and highlight the important impact of the concept of abjection, which historically has been silenced in the health sciences.

PART I
Fluids and Transgression of Boundaries

Chapter 1
Blurring the Boundaries: Breastfeeding and Maternal Subjectivity

Virginia Schmied and Deborah Lupton

Introduction

The majority of writings about breastfeeding, whether academic or lay, are profoundly in favour of the practice. The professional accounts of medicine, nursing, midwifery, public health and public policy continually emphasize that ‘breast is best’ for infants, the environment and global economy (Meershoek 1993, Smith and Ingham 1997)¹. It is claimed that breastfeeding is essential for bonding or securing the relationship between a mother and child (Virden 1988, Dettwyler 1995) and that it promotes the health, development and psychological wellbeing of the infant (Walker 1993, Riordan 1997).

In these accounts, the decision to breastfeed is largely considered a matter of individual choice and rational decision making. There is also a focus on the biological aspects of breastfeeding to the exclusion of insights into how the practice contributes to a woman’s sense of self and embodiment. Medical and nursing accounts, while claiming the significance of the intimate contact between a mother and infant, predominantly frame this connection around a biological or ‘natural’ account of symbiosis, emphasizing anatomical functioning of the breasts and the production of breast milk, particularly the action of hormones (see Henschel and Inch 1996, Royal College of Midwives 1996). Even in anthropological accounts, a strong link is often drawn between biology and breastfeeding (see, for example, the edited volume by Stuart-Macadam and Dettwyler 1995).

Nor has this dimension of breastfeeding been addressed adequately in other disciplines. Indeed, some commentators are puzzled by the lack of critical debate from sociologists and feminists in the topic of breastfeeding (Blum 1993, Carter 1995, Maher 1992). Where this debate has occurred, writers have mainly articulated the possibility for breastfeeding to be seen as an expression of women’s power, providing new, positive ways to view the unique features and capacities of women’s bodies and subjectivities. Van Esterik (1989: 107), for example, insisted that ‘the vague murmurings or submerged discourse about the power to nurture’ should be seized by women to reassert feminine values. Sichtermann (1983) stressed the potential to recapture the lost eroticism of the breasts and celebrate breastfeeding as a form of female sexuality and sensual pleasure. More recently, Blum (1993: 300) argued that, as a unique experience of the female body, breastfeeding can provide a deeply satisfying interlude of intense engagement with and delight in one’s child.

The present chapter contributes to a sociological and feminist understanding of breastfeeding in three ways. First, we overview some of the sociological and related anthropological and feminist literature that moves understandings of infant feeding decisions and practices away from the biomedical and health promotional discourses that dominate current debates on infant feeding. Second, the discussion draws upon our own Australian research using qualitative methods to explore women’s lived experiences of breastfeeding and the discourses upon which they draw when articulating and making sense of these experiences. Third, we argue that understandings of the breastfeeding experience can be strengthened by incorporating phenomenological and symbolic perspectives on women’s embodiment, particularly those offered in the work of feminist philosophers such as Julia Kristeva, Iris Marion Young and Elizabeth Grosz.

The Sociocultural and Economic Context of Breastfeeding

There are few accounts in the literature on breastfeeding that canvas the diversity of the breastfeeding experience or examine the ambivalence about or resistance to the imperative to breastfeed that women have shown over many years. The exceptions are those writers who draw upon data from women’s own accounts of their breastfeeding decisions and experiences (see, for example, Carter 1995, Hoddinott 1996, Hoddinott and Pill 1999, Maclean 1990, Murphy 1999). These writers often challenge the accepted wisdom that ‘breast is best’ for both mother and infant. They argue that breastfeeding decisions and experiences are complex, related to such factors as a woman’s physical heath, the health of her baby, the needs of her other children and family members, the family’s living conditions and other demands on the woman’s time and energy. They demonstrate that rather than being an individual act, breastfeeding (or the decision to bottle feed) is structured through prevailing sociocultural meanings and economic conditions.

Carter (1995), for example, highlights the resistance that women have shown over many years to the medical imperative to breastfeed. She analyses women’s experiences of breastfeeding across a number of generations. Carter notes that for many women in the period from the 1920s onwards, ‘breastfeeding was associated with exhaustion, poverty, discomfort, embarrassment and restriction as well as authoritarian hospital practices’ (1995: 90). Indeed, for the majority of women interviewed by Carter, breastfeeding represented hard work. For some women, bottle feeding actually offered some respite from the demands of childcare, as it could be carried out by fathers or others.

Both Hoddinott (1996) and McIntosh (1985) conducted studies of women from lower socio-economic groups. They concluded that the personal and social context within which breastfeeding takes place is more important than knowledge and attitudes about breastfeeding in determining whether or not a woman decides to breastfeed. Further, while there is evidence that the return to paid employment has an impact upon breastfeeding decisions, in reality this tends to reflect socio-economic conditions. In Australia and other Western societies, many women who have completed a high-school or tertiary-level education or hold higher-status occupations possess a degree of control and autonomy over their employment options. These women are more likely to receive paid maternity leave, have the option to work fewer hours and have more flexible working conditions, all of which facilitate breastfeeding (Hills-Bonczyk et al. 1993, Galtry 1997, Lindberg 1996)².

It has been argued by other commentators that breastfeeding decisions and practices are embedded within, and thereby draw meaning from, a specific social and cultural milieu (Baumslag and Michels 1995, Maher 1992, Morse and Harrison 1987). In Western cultures, powerful discourses and expectations continue to prescribe the appropriate length of time women should breastfeed and where and in front of whom they should expose their breasts to do so (Morse and Harrison 1987, Murphy 1999).

One of the most commonly voiced sociocultural accounts relates experiences of breastfeeding to the cultural meanings attached to the breast. Some commentators argue that the preoccupation in Western societies with the breasts as objects of sexual gratification is particularly influential in women’s decision whether or not to breastfeed (Baumslag and Michels 1995, Palmer 1988, Rodriguez-Garcia and Frazier 1995, Van Esterik 1989). In Western societies the breasts are fetishized as powerful symbols of feminine sexuality, which has important implications for how women feel about exposing their breasts to feed in private or public domains (Young 1990).

It is not surprising, therefore, that a number of empirical studies identify the discomfort that women face when trying to breastfeed in overcrowded living conditions because of the need to expose the breasts to others’ gaze (Carter 1995, McIntosh 1993). The thought of embarrassment and discomfort at breastfeeding in public is used by some women as a justification for their decision to bottle feed and as something that must be overcome or ‘managed’ to preserve modesty by those who decide to persevere with breastfeeding (Hoddinott and Pill 1999, Murphy 1999, Stearns 1999). Other studies have also identified the dissatisfaction or distress women may experience in relating to the physical sensations of breastfeeding. McNatt and Freston (1992) found that women who had not felt successful or satisfied in their feeding experience described discomfort and a lack of pleasure in breastfeeding as reasons they were not ‘successful’.

Further, the continual demands made of a mother from her breastfeeding infant can be experienced as physically and emotionally exhausting. Balsamo et al. (1992) found that, for many of their interviewees, breastfeeding on demand was often conceptualized as ‘chaotic and dangerous’ for women and the baby was portrayed as ‘encroaching’ on a sense of self. Maclean (1990) also describes the dramatic changes breastfeeding brings to women’s lives and their dislike for their lactating breasts. Britton (1997) and Morse and Bottorff (1989) note the feelings of distress or revulsion that some women describe in response to the sensations of the ‘let down’ reflex and the leaking of breast milk.

Breastfeeding, Embodiment and Subjectivity: Our Research

To further explore that ways in which women experience breastfeeding, particularly in relation to notions of selfhood and embodiment, we draw upon empirical data and analysis from a recent qualitative and longitudinal study of first-time parenthood. 25 women living in Sydney and their partners participated in a study of first-time parenthood. A series of semi-structured interviews from late pregnancy until three years following the birth of their first child were conducted with each participant³. Interviews were carried out just before the birth of the child, between two and 10 days after the birth and then at the intervals of four to six weeks, 10 to 14 weeks, five to six months, one year, 18 months, two years and three years after the birth. Our discussion here focuses on data from the earlier interviews (up to five to six months following the birth).

The questions asked of the female participants focused on their expectations and experiences of first-time motherhood. Breastfeeding was but one of the many aspects of these expectations and experiences that were explored in the interviews. Nonetheless, our analysis of the interview data revealed that breastfeeding was central to these women’s experience of motherhood, especially in the first few weeks and months following the birth.

In contrast to the varying degree of commitment to breastfeeding found among women in the work of Hoddinott (1996) and Murphy (1999), all these Australian women portrayed breastfeeding as a crucial part of maternal identity. Prior to the birth, all of them said that they intended to breastfeed, and the majority was strongly committed to breastfeeding. This commitment made by the women we interviewed may, in part, be attributed to their socio-economic status (predominantly middle-class)⁴. However, it also is reflected in comparative breastfeeding figures for Australian women overall, who are more likely to initiate and continue to breastfeed than either British or American women (Murphy et al. 1999).

All the women in our study believed that breastfeeding was ‘natural’, and therefore desirable, crucial to their relationship with their baby and best for their baby’s health. Furthermore, breastfeeding represented ‘good’ mothering. Most women were prepared to ‘persevere’ with breastfeeding to achieve their identity as a breastfeeding mother. This is particularly clear in Jane’s account: ‘I think [breastfeeding] is a major motherhood thing, that you have to try and persevere and accomplish’. Breastfeeding was something that the women wanted to master, to get under control.

As a result of their strong commitment to breastfeeding, all the women participating in this study began by breastfeeding their babies. One woman stopped feeding at five days because she was experiencing difficulties, and four other women weaned between six and 12 weeks. Three months after the birth, 20 women continued to exclusively breastfeed. At six months, 18 women were still feeding, and 12 women continued to feed their babies to between one to two years of age.

None of the women in this study initially planned to combine breast and formula feeding. Only four women returned to paid work within the first six months. Two weaned their babies before returning to work, while the other two intended to express breast milk once back at work. Both of these latter women found, however, that in practice expressing breast milk was difficult and their infants were weaned quite soon after their return to work.

Following the birth, the women talked in great detail about breastfeeding. They reiterated their commitment to breastfeeding and the discourses of bonding and the child-centred account of ‘breast is best’. In their accounts, the embodied experience of breastfeeding emerged, as not only shaped by the dominant discourses of childcare and motherhood, but importantly also as representative of an extra-discursive, sensual and highly emotional experience that was difficult to describe in words. Phrases such as ‘nobody told me breastfeeding would be like this’, ‘it’s hard to explain it’ and ‘I can’t describe it’ were common. None of these women had been able to imagine or prepare for the intensely embodied nature of breastfeeding. As Sally put it:

Because you don’t have that much sort of physical, not contact physical association with things that you do in life so much – [breastfeeding] is one thing that is so … that’s all there is to it, it’s so physical that – well I don’t think that I have ever done anything that makes you feel so much a part of what you are doing. It’s very strange.

It was evident from our data that most of the women in the study responded to breastfeeding in one of two contrasting ways. For some women, the breastfeeding experience was pleasurable and intimate, a vital means of emotional connection to their infants, but for others it was difficult, unpleasant and disruptive. In the remainder of the discussion we examine these very different ways of experiencing breastfeeding.

‘Still Part of Me’: Breastfeeding as a Source of Intimate Connection

Bottorff (1990) argues that the image of breastfeeding as ‘gift giving’ is seen as a motivation for many women to ‘persist’ with breastfeeding. Within this embodied closeness or intimacy, a woman and her baby ‘become one’. This feeling of companionship and closeness makes breastfeeding easier to practise and to continue: ‘it becomes almost effortless’ (1990: 206).

This sense of pleasurable connection was indeed evident in the accounts of some women in our study. At differing times following the birth, about a third of the interviewees spoke of a sense of connectedness, continuity or oneness between themselves and their baby. This was a powerful experience, described as ‘wonderful’ by these women. They spoke of feelings of interdependence, harmony and intimacy shared with their infant. Lyn, for example, described breastfeeding in the following way: ‘[it’s] a special kind of moment, when you breastfeed, and you look down and they’re looking at you and you think, “Oh, this is when they need you the most”. You know, they really need you. It’s a wonderful thing to breastfeed’.

In their descriptions of their breastfeeding and relationship with their babies, other women used the imagery and metaphors of harmony, intimacy, giving of self and exclusivity. Kerry described herself and her baby as a ‘package’, Julie saw her baby as ‘still part of me’ and Sally explained she would feel ‘alien’ if she did not breastfeed. They were comfortable with, indeed actively enjoyed, ‘sharing’ their body with their baby. To maintain this intense embodied and emotional relationship, these women participated in subtle but powerful practices that excluded others. Most commonly this consisted of establishing ‘special times’ with the baby where the two were alone. As Lyn described it: ‘I like the morning feeds: he lies up in bed with me and I feed him in bed and then take all his clothes off and he’ll have a kick and we talk. That’s my favourite time, when it’s just me and him’. Similarly, Kerry said that she particularly enjoyed sleeping in the spare bed with her baby when he wouldn’t settle in the middle of the night.

In breastfeeding their infants, these women said that they were gaining personal rewards greater than they had thought possible. Megan described the pleasure she gained from gazing at her baby while he breastfed: ‘there’s just some really beautiful moments, just looking at [him]. It’s the closeness, that intimacy’. A desire for ‘skin to skin’ closeness prompted Christine to bathe with her baby. She elaborated on the sensual nature of her breastfeeding experience: ‘I fed him in the bath. But it was such a nice feeling! I was lying in the bath and I thought, well, “Oh, this is lovely!” Their bodies are just so perfect’. Cecily also savoured some of the pleasurable moments of breastfeeding: ‘I love the closeness, the warmth and I love looking at his little face if he comes down to the breast and he’s got it in his view and even his mouth gets ready. He latches on, gets his mouth in the position and he starts to breathe [faster] and get excited’.

These profoundly pleasurable experiences, continuing for some women for many months beyond birth, challenge the assumption of psychodynamic separation of the body/self of the mother and baby at birth or within the first month following birth that is described in early psychoanalytic work (for example, Deutsch 1944, Bibring et al. 1961, Rubin 1984). These women articulated few or no difficulties with the notion that their bodies/selves and that of the babies were inextricably interlinked, the boundari...

Table of contents

• Cover
• Half title
• Title Page
• Copyright Page
• Table of Contents
• List of Figures
• List of Tables
• Notes on Contributors
• Foreword
• Acknowledgements
• Introduction – Abjectly Boundless: Boundaries, Bodies and Health Work
• PART I FLUIDS AND TRANSGRESSION OF BOUNDARIES
• PART II ABJECT POSITIONING
• PART III CONTAINMENT OF BODIES
• Conclusion – Defacing Horror, Realigning Nurses
• Index