Friday 29 July 2011

The elephant in the room: breastfeeding and NFP

This post isn't about NFP pros and cons, it's about whether political correctness or perhaps ignorance is making us approach fertility awareness in an unscientific way. It's also about whether our approach, in the way that it ignores and therefore inadvertently subverts the natural order is, in some way morally flawed.

Amongst other things I'm a trained and qualified lay breastfeeding counsellor. I've racked up enough clinical hours in a voluntary capacity over the past nine or so years to qualify to sit the IBCLC certification, normally reserved for medical professionals. I only mention this to point out that, apart from my other areas of interest [(doctoral dissertation (literature) and professional life (IT), and hobbies (small mammal colour genetics)]  breastfeeding is my specialist subject. Even though I'm no longer active as a counsellor, the journal Breastfeeding Abstracts still drops onto my doorstep every quarter: it's fascinating stuff.

But what does this have to do with NFP? I'm asked this a lot when I get onto my breastfeeding and NFP hobby horse. Breastfeeding is just one of many parenting choices that some mothers make, right? Natural family planning is something completely separate, right? Wrong.

I first got thinking about the relationship between breastfeeding and Catholic mothering about six years ago when I was helping a mother who was having difficulties nursing her third child. She had nursed her first two easily but things were more complicated with the third and, having been failed by the NHS, she had sought out help from a breastfeeding charity. She was about my age and over the next few weeks we had some interesting conversations. One of the reasons that she was determined to nurse her baby was because she was a Muslim and, as she told me, "breastfeeding is an important part of our religion". Always competitive, I bounced back, "and part of mine too" while thinking "erm, exactly why did I say that?".

I had been reading a fair bit about the Theology of the Body at the time, and was convinced that Blessed Pope John Paul II's definition of self-giving was a perfect illustration of the nursing relationship. Around the same time I read "Breastfeeding and Catholic Motherhood" and saw that Sheila Kippley had explicitly drawn the same conclusion. More importantly, I accepted the necessity of openness to new life as a fundamental aspect of Catholic belief, but saw an inherent contradiction in the absence of any discussion about breastfeeding as part of the same conversation.

A few years earlier our diocese had held a consultation to find out how to make parishes more family-friendly (or at least that's how it was presented to us in the parish we were in at the time). My husband and I and our then only child went to the meeting along with a friend and her husband and toddler of a similar age. When asked what the parish could do for families we all asked to have a Billings or other NFP counsellor accessible to the parish. What we were eventually given, was a "ministry of welcome" which was as much use as... well, chocolate teapot metaphors in the combox please. This "consultation" got me thinking about NFP in the parish context and comparing the families who wanted it and their reasons for wanting it with those mothers I'd been working with as a breastfeeding counsellor. The families in the parish were often afraid of having a second (or subsequent) child too soon after a first; on the other hand, many of the mothers I knew through my breastfeeding work were keen to have another baby sooner rather than later and were looking for help in ways to increase their fertility. The difference was that the latter group were often breastfeeding in a biologically normal manner: that is to say for a biologically rather than culturally normal length of time (>=2 years). The mothers in the parish group were almost all either using artificial milk, the cultural norm, or mixed feeding, and/or weaning within the first year. They had a rapid return to full fertility and often had a second or subsequent baby before nature would have allowed had natural law been followed. At that time the cultural norm was a maximum of six months (anything else was seen as a bit wacky), encouraged by the NHS, against all scientific evidence which pointed (and still points) towards a minimum of two years nursing (WHO guidelines). A comment I read many years ago (I don't remember where) that really struck me was that the only thing that the Vatican and the World Health Organisation have ever wholly agreed on is breastfeeding.

This is about following Natural Law. God's perfect plan for families includes breastfeeding. Breastfeeding is nature's way of spacing babies. It's nature's way of ensuring that the mother's body had had time to recover, that the nursing baby is strong enough and mature enough to deal with a sibling, that everyone has had time to catch their breath between births. Research shows that for European women, with natural duration breastfeeding (i.e. nursing a baby for a natural amount of time) menstruation returns (on average) between 13 and 15 months post-partum (depending on the study). Even if a mother was to conceive on her first visible cycle, she would have a minimum gap of almost two years between her babies. However if she's still nursing her toddler several times a day as nature intended, her fertility will probably be reduced for several more months. Thus many mothers who are committed to natural duration breastfeeding find that they actually need to change their nursing pattern (dropping an early morning feed works wonders) or even wean their child in order to conceive their next baby. These women allow breastfeeding to maintain a subfertile period of months (sometimes years), allowing nature to space their babies. Yet in Catholic parishes, we're teaching people how to avoid their fertile period while not talking about breastfeeding at all. We are creating, or at least condoning, an artificial rupture with the natural order. Why?

Breastfeeding is a hot topic: feminists see it as a way for flat-earthers to chain women to domestic slavery. "We won't be equal with men," they argue, "until we're able to share parenting equally". As a sociological construct, the concept of "sharing parenting equally" might just be able to pass muster, but from a scientific perspective it's an utter nonsense. There is nothing equal about parenting -- men and women have differentiated roles that should be embraced not ignored. Some social conservatives  appear to see breastfeeding as some sort of feminista statement, and I've read more than one unpleasant comment associating breastfeeding with "feminazis" over the years. Breastfeeding isn't a feminist issue. It's shouldn't be an "issue" of any kind. It's simply what mothers with babies do in order to feed them, stimulate the development of their neural pathways, widen their dental arch, provide immunological support to an immature system,  and kick-start the endocrine system. And that's just (some of) what it does for the baby; there are profound physical effects on the mother as well: positively impacting behaviour, emotions, and fertility.

So it's not all about the food. This means that we can wipe the "breast vs bottle" arguments from the slate. Research over the past decade or so has proven what mothers have instinctively known for millennia: there's more to breastfeeding than food. The "first milk" or colostrum is not a milk at all, but a secretion that kick-starts the endocrine system: this is why babies who miss out on this precious fluid in the first days of life have a considerably raised risk of developing diabetes later on in life. The immunological benefits of breastfeeding are better known, as are the decreased risk of allergies. Less well known is the benefit to dentition -- breastfeeding in the second year of life is nature's way of widening the dental arch, thereby decreasing the chance of overcrowded and misaligned teeth. Did you ever wonder why more and more people have misaligned teeth and need braces? It's not simply down to vanity. One American dentist did, and he did a massive retrospective study of orthodontic patients, finding a direct correlation between not being breastfed  and needing dental work for malocclusion. Braces and expensive orthodontics were not in God's plan, but breastfeeding for the first couple of years clearly was. Then there's the neural pathway development: the skin-to-skin contact facilitated by the nursing relationship is the primary mechanism stimulating the development of neural pathways in the early weeks of life; this is part of “building the brain” outside the womb, creating the ability for a wide range of emotional responses. I could go on, but this post isn't about the wonders of breastfeeding, it's about why we, as Catholics, don't include this vital aspect of fertility in our fertility education.

Clearly humans can survive without being breastfed. I'm not arguing that point. I wasn't breastfed, and I'm still reasonably intelligent, relatively sane, and if not glowing with health, at least I'm still alive. This isn't about bare minimum: if we Catholics believed that bare minimum was good enough we'd hand out condoms and tell teens to only use them if they really really can't do otherwise. But we know that's wrong. What is just as wrong is subverting the natural order and calling it “Natural family planning”.

But what about those women who can't / won't / dont' want to breastfeed. I have no patience with “won't” and “don't want to”. You have a baby and you don't want to feed it as God intended: tough. I bet you don't fancy changing nappies, being woken up twelve times a night, and cleaning projectile vomit out of your hair either, but you'll have to do it at some point  (or possibly several) as a parent. As for those who “can't” -- well, that's different. Fewer than 1% of mothers have a medical problem that makes breastfeeding impossible; these can be either physical (mastectomy) or endocrinological/hormonal affecting milk production.

 Many of us have neighbours / mothers / sisters / friends who have been “unable” to breastfeed because they have been told that they don't have enough milk, aren't producing enough milk, will never produce enough milk. It is far more likely that they were not supported properly, and were attended to by people with an incomplete knowledge of lactation than that they fall into the <1% with a physical impairment. Having spent years dealing with the fall-out from women discharged from hospital or by community midwives, I think that learning and support are the two things that would make a big difference to breastfeeding success. It is my perception (and I have nothing but my own experience to back this up) that a greater proportion of Catholic mothers breastfeed (for some length of time) than among the population at large. There is a huge potential support network of mother-to-mother help available. Another option would be to co-opt existing breastfeeding support agencies like La Leche League into NFP programmes and to provide free helpline numbers at a parish level (La Leche League is an international single-issue organisation providing breastfeeding support set up by seven Catholic women and their Catholic GP in 1956. It was named after a shrine to Our Lady. Whilst having no relationship with the Catholic Church, there is nothing in the organistion's beliefs that contradicts Catholic teaching - it exists simply to support and provide information to mothers who wish to breastfeed and takes no stand on other issues).

So what does this all have to do with the Catholic Church? Well, if we believe that God created us in His likeness, and that the natural order is a good thing, then we should seek to maintain that natural order. This means encouraging breastfeeding as part of NFP programmes or, better yet, treating it as the norm within the context of family fertility awareness teaching. Breastfeeding might be natural, but it is a learned skill, and over the past few generations we've seen a complete rupture with the past in terms of mothering particularly with regard to breastfeeding.  Marriage preparation and NFP classes should be scientifically as well as morally coherent. They should emphasise the whole picture with regard to fertility, not just the “contracept-or-not” bit thereby allowing parents-to-be to see and understand the whole big beautiful picture of procreation that God has given us.

Pictures from the Breastfeeding Art Gallery with thanks

UPDATE (5th August 2011): More on NFP here


  1. What is your opinion of mothers who take prescription medications (e.g., antidepressants) which can be passed into the breast milk and possibly harm the child? Do you think that those mothers should stop taking those medications and breast-feed, or give the child baby formula instead?

  2. Resources like LACTmed on Toxnet ( part of the United States International Library of Medicine ("A peer-reviewed and fully referenced database of drugs to which breastfeeding mothers may be exposed. Among the data included are maternal and infant levels of drugs, possible effects on breastfed infants and on lactation, and alternate drugs to consider. "), the University of Texas pharmacology database behind and Thomas Hale's annual review (Medications and Mothers' Milk: A Manual of Lactational Pharmacology see ) are all up to date resources that any reputable doctor or breastfeeding counsellor or lactation consultant should consult before suggesting a change of medicine. A concerned mother can also turn to La Leche League who should be able to refer her to a medical liaison person (a doctor who donates his or her expertise) who will be qualified to assess the situation. In the UK BFN (the BreastFeeding Network) also has a free drugs line that mothers can phone to be given accurate information about the medications that they are using.

    I have worked with many mothers using anti-depressants who have breastfed long term: some of these drugs are much safer than others, and those using the older or less safe versions often needed a change of prescription. The infant dose varies significantly between antidepressants, but a safe, acceptable alternative is almost always available. Importantly, breastfeeding is an important protective factor against PND and the physical, hormonal and emotional consequences of cessation of lactation on the mother must not be discounted.

    It is important that doctors and other medical personnel check the facts and the most up to date evidence before suggesting something as radical as either stopping breastfeeding or ceasing taking a medication. Sometimes a mother needs to bring information to her doctor and request a change of medication; almost every medication has acceptable alternatives, some of which may be better for a lactating mother and baby. Unfortunately, all too often, it's considered easier just to stop breastfeeding, the assumption being made that one drug is very like another. The pharmacology research evidence shows that this is not the case. Doctors should be encouraged to "look it up" if they don't know.

    There are few medications that are truly incompatible with breastfeeding, chemotherapy being an obvious example where breastfeeding must stop. With most medicines, the dose passed through into the milk varies dramatically from medication to medication (as even medicines with similar effects use different molecules): therefore the resulting equivalent infant dose and its effect can be very different. Thus while a change of medication is sometimes advisable, it is rarely necessary to either stop taking medication for a particular condition or to stop breastfeeding. It is virtually never an either/or situation.

  3. Thank you for this excellent and insightful article. I breastfed all of my children for extended periods, and found it sad that some of my midwife colleagues were less than helpful to mums who wanted to breastfeed........