A long time ago, in a world far, far away, lived a (fictional) family in the 1400's. Traditions at the time dictated that the rich and famous had access to breast milk, and the poor working class/lower class did not. If they survived pregnancy and birth, and were able to nourish their own infants - they would. If they had access to a wet nurse, they would attempt that. More often then not - women who could not lactate would make a feeding replacement from grain mash and water (not necessarily as safe as what comes from your tap). Needless to say - mortality rates were far higher than they are today. The rich and famous, of course, also had access to wet nurses. To feed your baby, with breast milk, made sense. (Jan Riordan is my source on this)
Surges throughout history waxed and waned - the church, of course, had opinions on breasts and dictated how newborns were fed. The world's rich and famous have always had opinions of their own on how to rear children. As have medical professionals. Even today - if you ask around - the opinions are loud and proud. One would expect that these surges and trends will continue through the eons.
In contemporary times, we look to celebrity, we look to peers, and we look to health care professionals to make our parenting decisions. As a health care professional, as a graduate of a school of nursing, I have pondered why I have developed my current paradigm and why the shift in my own profession is so narrow in both scope and practice.
When you look at the praxis involved in developing nursing practice paradigms related to feeding of infants, you have to look at the primary attitudes that circulate in contemporary times.
1. Birth culture in contemporary times dictates that when you are pregnant, you should see your physician, who will "diagnose" your pregnancy via blood or urine, and will then set you on a course through your pregnancy. Your physician will tell you to eat healthy and will be there along the way to categorize your symptoms into normal, abnormal, and questionable. You will see an Obs/Gyn, you will take birth classes, and you will attend the hospital to have your baby. Nursing care will take you from the birth suite to home, and from there your family physician will handle well-baby, sick baby, and your post partum follow up.
2. Primary knowledge of infant feeding practices comes from the "breast is best" world. Your medical professionals know that breast milk provides immunity. Your medical professional knows that formula will need to be given when breast feeding does not work. Your medical professional knows that pumps and creams and mastitis and thrush all co-exist in a wonderful world of solutions. Your medical professional will send you to a Lactation Consultant, who will know the tips and tricks and will get you on your way.
3. The personal paradigm - be, it, previous clients, your own babies, your friend's baby, the lady across the street, the lady in the mall, etc. Not only do you build upon your knowledge, but you also absorb on a constant basis. If you work in the birthing industry, you hear the wishes of the women in practice, as well as the stories about why infant feeding needs to work or does not work. Media is also a constant and continuous flow of stimulus.
The praxis and general consensus of how infants will be fed is typically going to look at the nursing dyad together, with the emphasis put onto the mother. Mothers fail to make breast milk and are given a solution including pumps and supplements. Rarely does the investigation lead to the "bigger picture". The birthing process is finished once the perfect little baby has arrived. The birthing process is still taking place largely in hospital, where many hands have examined both mother and baby.
Eventually mothers will look to peers or family, ask her partner, struggle, and then seek further advice. If, they have survived and endured running the feeding gauntlet, and have eventually found their solution - they will have a combination, or a success/failure.
What if? I like to write a lot about the utopia - and, I like to hear about the ideal course happening. On occasion, all of the stars align, and a woman has a normal course of birth and nursing. Changing the paradigm has a lot to do with changing attitudes around women and pregnancy, which is a given. Separating mothers from their babies is consistent in industrialized countries - separation and milk supply go hand in hand - otherwise, we'd all be lactating all of the time (it's a true story if you think about the evolution of mammals). The other side of this, is changing the attitudes about the bigger picture.
Having a close connection with women and their stories has done more for developing knowledge and praxis then any course in nursing ever did. From there, looking at bigger pictures and looking to those who hold knowledge has made a big dent in my own practice. Finally, looking for solutions that may exist within the confinements of the medical-model of birth has cemented it in.
Evolving and changing my own paradigms - and, more on this to come.
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