When Breastfeeding Sucks

What you need to know about nursing aversion and agitation

Zainab Yate

• Publisher: Pinter & Martin Limited
• Year: 2020
• ISBN:
  9781780666884
• Topic: Medicine
• Subtopic: Gynecology, Obstetrics & Midwifery

Many mothers and those who support them do not know that they can experience negative emotions associated with breastfeeding. In modern society breastfeeding is often used – problematically – to exemplify myths about motherhood and maternal love, and is bound up with ideas of what makes a 'good mother'. In this context nursing aversion and agitation – intense, distressing feelings that are experienced by the mother during breastfeeding – can be both unexpected and hugely upsetting, particularly when women may have already overcome significant challenges in order to breastfeed.

In When Breastfeeding Sucks Zainab Yate examines what we know about this poorly understood aspect of infant feeding, in a carefully researched discussion that will be valuable for individual mothers who may be suffering, and the breastfeeding supporters who work to support them.

PART I

The Love and The Hate

1

Touch and ‘Skinship’

Touch that builds relationships, touch that breaks it

The notion that physical closeness and skin contact can create a kind of intimate bond is something instinctively known to humans, and has been discussed extensively in academic and cultural literature. Most parents know the importance of skin-to-skin, and that breastfeeding is inextricably bound to this repeated physical closeness. Yet, when experiencing aversion, the notion that this repeated contact with skin builds a loving and secure relationship is brought into question. Especially when we consider the emotions aversion triggers of anger or agitation, intrusive thoughts and the ‘urge to de-latch’ and ‘run away’ or ‘push the nursling off’. Although many can suppress this urge, breastfeeding with aversion can mean prematurely ending a breastfeeding session because of these emotions and thoughts – with both parties in tears. This seems to be the exact opposite of what closeness, skin contact and breastfeeding is supposed to bring.

With what many of us consider loving mothering to be – including responsive parenting and night-time care – we may find ourselves as mothers spending much of our time holding, feeding, and touching our babies, infants or children, often for hours each day, regardless of their age. While the immediate dependency of a newborn for survival is demonstrably time-consuming, when we consider teething, illness, family disruption and a whole array of other factors, mothering responsively is always time consuming in the early years and doesn’t ever actually stop. To understand these daily (and nightly) activities with the intimate nature of the breastfeeding relationship and how this relationship is compromised when aversion strikes we turn now to look at the concept of skinship.

Skinship is actually originally an English word, but is now considered to come from the Japanese, and is a mix of two words or a ‘portmanteau’ of the English words ‘skin’ and ‘friendship’. It uniquely describes an interaction through skin contact that builds love or closeness, and was initially, and historically, used to convey touch between a mother and child. Skinship is a widespread, deeply rooted concept in traditional and modern-day Japanese culture, although it now more commonly refers to intimate touching in romantic relationships. Regardless of its application to a relationship, touch and touchability are a key theme of the Japanese concept of skinship. And skinship can help us understand the importance of touch for mothers and how this relates to aversion.

The meaning of touch

To be human is to feel things, to touch and be touched. Touch is a form of social glue as it binds sexual partners into lifetime partners, siblings in families and even individuals in a work team. Different forms of celebratory touch in various sports have been shown to affect game outcomes for the better. To be human is also to be emotional: touch or even a sense of touch will arouse different emotions and is intrinsically emotional. There is a deep connection between emotion and the sense of touch. We know severe touch deprivation causes neuropsychiatric problems, including cognitive delays and attachment disorders, stunted growth, gastrointestinal problems and overall negative effects on the immune system. The well-known story of babies and children in Romanian orphanages that were fed, but not ever held, taught the world that touch is a biological condition necessary for human development, and for human existence itself. The children in the orphanages often did not survive long, and those that did suffered lifelong effects from neglect. Psychologist Harlow’s famous experiments on rhesus monkeys had also suggested what we now know: frequent touch is needed in the first two years of life, or problems from a lack of touch will persist for the rest of life, regardless of whether touch interventions occur afterwards. Touch, or touchability, continues as a main and basic defining characteristic of all familial relations, of course with the proviso that touch is from those you trust or are close to. And this touchability as the foundation of the basis of skinship is premised on closeness and (consensual) intimacy.

The beginning of this touch-intimacy for a mother and nursling will start at birth, ideally with the physical practice of skin-to-skin to allow the baby to root for the breast, to regulate their heartbeat, their temperature, and to calm them after the unsettling journey of birth. The benefits of skin-to-skin are not disputed, and much research has been put into clinical practice all over the world to ensure that mothers and babies are able to have skin-to-skin – ideally from the very first minute, but if not then during the first ‘golden hour’ of life outside the womb, regardless of delivery route. Breastfeeding itself necessarily results in skin-to-skin contact due to spatial proximity, and is attributed to promoting and solidifying bonds over time. From the lips, mouth and cheek as a minimum, there is reciprocal skin contact for the baby and the mother, and the boundaries between the two of them are blurred, as you cannot really tell where the mother’s body ends and the nursling’s begins.^* It is generally understood that you cannot ‘touch’ one way, because touch is necessarily a two-way thing, as both persons will experience sensations of touch. A sort of reversibility.^** Breastfeeding, and therefore touch, to establish supply and to adequately nourish a newborn baby’s growth, happens very regularly: at least every 2–3 hours in the early weeks and months.

Alongside this outward physical contact, there is a deeper, more ephemeral bond which Tahhan calls ‘touching at depth’ in her book on the Japanese family that looks at bonding through intimate spaces. She outlines a sort of relational understanding of touch that is not located in a particular part of the body.^* That this kind of special ‘touch’ grows with physical proximity and touchability is not often spoken about or celebrated, because of recent decades of incorrect advice to ignore babies’ needs as they were considered ‘manipulative’. This advice has led to responsiveness being frowned upon, and age-old bed-sharing practices and night-time care to be shunned by society in many Western countries.

‘Anshin’ is the Japanese word that describes what comes with shared sleep (‘soine’), or bed-sharing, which is a practice that is woven through the fabric of family life in many parts of the world. The state of anshin is the ‘feeling of contentment and relief’ or ‘peace of the heart’, and the Japanese consider that bed-sharing and breastfeeding facilitate this anshin for parents and children: it benefits the whole family. The intimacy of anshin that arises with the particular nature of a relationship formed with skinship is at the very foundation of familial relations and family connection, second only to sharing of blood and DNA. Perhaps because of this, anshin is something that we assume will be as beautiful and natural as breastfeeding or mothering itself. And so long as the boundary-less connection of positive touch exists, and feelings of contentment and security are felt by mother and nursling, anshin can be a beautiful and natural development of the all-encompassing space which the breastfeeding relationship can take up. When breastfeeding is working, and is easy for a mother, it can be relaxing in a deep way, which can promote skinship and anshin. But when breastfeeding is painful, or uncomfortable, or becomes difficult for a mother to sustain, it will not promote this contented state. And many mothers do not realise there are challenging parts to creating anshin through skinship – with personal, physical and emotional obstacles to overcome when breastfeeding responsively during the day, and co-sleeping or bed-sharing at night as so many breastfeeding mothers do.

When touch is a trigger

Intimate touch is often assumed to be consensual when we think of a mother and nursling, and a mother’s consent to be touched is presumed if a baby is the other party in the interaction. This makes sense as babies are not autonomous persons, they cannot make rational decisions and are wholly dependent on their mother or primary caregiver for their survival. They are not required to gain consent to touch because they cannot. Yet some women have negative feelings that can arise from being touched when they do not want to be, or in a way they do not want to be. I have seen this less often in the newborn period, although it does occur, but certainly touch becomes an issue as mothers breastfeed into toddlerhood and breastfeed older children. There are aspects of bodily autonomy, and feelings of not consenting to being touched, which are not generally addressed in breastfeeding mothers, because consent is generally understood in an adult-to-adult capacity and not within a concept of maternal autonomy.

I just don’t feel like I have any power over my body, it’s like I don’t really own it anymore as the milk is theirs, and when they clamber on me and reach into my top to nurse I can’t say no as they need to feed. Kathryn, Wendover

We think of touch as a unified sensation, but there are many different kinds of nerve endings that specialise in the transfer of certain kinds of information. For example, merkel endings are dense in sensitive parts of the body, like the tongue, the fingertip and the cornea.^* We have differing nerve endings for heat, cold, vibration, pressure and pain, and the density of each of these in a part of the skin gives rise to different personal experiences. So when looking at the importance of touch we must not assume that all touch is ‘good’, or even that all touch is important, but that specific facets of touch profoundly affect our human experience. And as we have different levels of sensory preferences and tolerance, perhaps due to our genetic makeup, touch can be uncomfortable or painful for some mothers but not for others. And touch is important when we look at aversion, because many argue that there are no sensations without emotions. In many ways we are just sensory-emotional processing machines, and all our nerve endings provide us with the information to process. All the streams of information from the merkel endings come to the spinal cord and then the brain. They are distributed into two different systems. The first is the somatosensory cortex. This registers where in the body you are being touched and how intensely. The second is the posterior insular, which is what gives different kinds of touch their emotional frequency or ‘tone’.^* Many of us think that certain sensations have an emotional tone, for example that being pinched or hit will cause a negative response, but it is actually only because these two systems are active at the same time that we get this kind of negative response. In short, not everyone will experience the same emotions with the same external stimuli.

Mothers with aversion speak about what triggers their negative emotions, including variations of different kinds of touch, movement or sensations and consequently the subsequent feelings that are not pleasurable and not welcome. Common triggers are nipple tweaking or twiddling, scratching, pinching, and even gentle stroking by their nursling. Sensitive parts of the body like the nipple can be culprit areas, but triggers are very individualised and can also be in other areas of the body depending on the kinds of touch. Triggers can also be exacerbated in certain situations, such as at night or in response to individual mothers’ external life pressures and expectations. On a very basic level, having to breastfeed when you do not want to, or when you feel you ought to be doing something more pressing, can exacerbate triggers – and so in turn cause aversion. And, as you can imagine, there can be an array of other reasons mothers may have to be triggered – whether it is painful to breastfeed, they are bursting for the loo, or they have to submit their thesis next week. We will explore these reasons and confounding tensions in more detail throughout the book, and I will show how it is normal to feel aversion as a manifestation of tension that pulls you in opposite directions, but how persistent aversion is a sign that something is not quite right. If changes or adjustments are not made, the negative feelings of anger or agitation that arise due to breastfeeding with certain kinds of touch can actually start to bring about an emotional separation between the mother and infant. It can lead to a physical separation because of de-latching or the ultimate need to wean the child off the breast. This is because aversion can create momentary feelings of uncertainty in the mother about her love for the nursling and her ability to mother, and also an uneasiness or incompleteness due to the fact that the physical form of intimacy no longer exists in the way it ‘ought to’. By this I mean it does not have the calm, loving effect that breastfeeding and skin contact with touch normally does. The reason for this may be in part because of oxytocin. Aside from its involvement in the milk let-down reflex, oxytocin is also released in response to low intensity stimulation of the skin – during touch – and positive interactions between people.^* Bluntly, it seems that the ‘oxytocin effect’ that breastfeeding is so well known for is not working for mothers with aversion. Is this purely because of a biological pathway that is not working properly? I wouldn’t think so. As we are such complex beings, there will be an array of factors that may contribute to what seems to be inhibited oxytocin. Contrary to the Cartesian assumption that the mind and body are separate, for a hug, kiss or human touch to be meaningful at all, more than just the physical body is needed, for both parties. Skinship describes bonding through touch, but there is an implicit assumption in the concept that it is touch that improves the relationship, not touch that doesn’t, or seems to make it worse. Whether touch is experienced in a positive way that builds a relationship, or a negative way that does not, is dependent on many interlinked and layered factors that we will explore throughout this book.

The concept of skinship is essential to one of the main themes of this book: the embodied experience and emotions of connection and disconnect in the intimate spaces of breastfeeding. Intimate touch between the mother and baby, which is argued to be one main form of skinship by Tahaan, is facilitated and o...