Woman: An Intimate Geography (29 page)

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Authors: Natalie Angier

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such as zinc and copper; they're rare in breast milk, but when they're there, the suite of milk proteins and sugars takes them up and guarantees they will not escape. Moreover, human babies in the past probably spent a bit of time rolling around in the dirt and picking up iron and minerals through an infantile form of pica. Babies put everything in their mouths, and they try to lick whatever they can. We see this as an unfortunate and risky little habit, but babies might do it for a reason: to lick up the occasional trace element their cells demand to perform and divide.
Infant formula cannot mimic breast milk, as we've learned, and as every new mother is told by every authority she encounters, and as every can of formula is required by law to warn, in the way that a pack of Marlboros must warn of cigarettes' lethality. Human milk is a solution of more than two hundred constituents, whose manifold roles have yet to be entirely understood. Nothing does just one thing. Milk sugars offer calories, and milk sugars allow other nutrients to be fully metabolized. The sugars of human milk and of infant formula are quantitatively similar but qualitatively different. Lactoferrin permits the scarce iron in milk to be "bioavailable" to the baby, and it also prevents pathogenic bacteria from getting their maws on the metal, which they need to survive. There is no lactoferrin in infant formula. The immune properties of breast milk are legion, and most of them are missing from formula, because the preparation of formula destroys their counterparts in cow's milk. There are B cells, T cells, macrophages, and neutrophils in breast milk, there are antibodies, there is gamma interferon, which stimulates the activity of the immune cells. The fatty acids in milk disrupt the membranes surrounding viruses, while lysozyme does the same to the cell walls of bacteria. Bifidus factor encourages the growth of benign flora in an infant's gut, the better to outcompete insidious strains.
Much research on breast milk over the past ten years has concerned hormones and growth factors. Here is where the human mammary gland is portrayed as a kind of brain, a self-replicating mind, feeding the developing brain of the neonate the proteins that its neurons require to differentiate. The mammary gland synthesizes gonadotropin-releasing hormone, for example, and deposits it in milk. Gonadotropin-releasing hormone is a protein best known as the product of the hypothalamus,

 

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located in the midbrain. In adults, it stimulates the gonads and may play a role in sexual behavior. We don't have a clue what, if anything, this hormone might do to a suckling infant, but there it is, swimming in the milk, at a concentration ten times that seen in the mother's bloodstream. Breast milk also has nerve growth factor, and thyroid-stimulating hormone, and factors given vague names like "mammotrope differentiating peptide." The human newborn is a weak, altricial little creature, a postpartum fetus, and it is possible that some of the factors in mother's milk are "obligate differentiation factors," required to orchestrate the full maturation of the infant's brain and other organs. Infant formula has some of these factors, but again, most of the equivalent peptides in cow's milk are destroyed by the processing necessary to make cow's milk digestible. In the absence of these factors, can the infant realize happiness, healthiness, and peak brilliance? We don't know yet. We don't know what these supposed differentiation factors and neuropeptide equivalents are for. It's logical to assume that they're necessary, or at least good for an infant, but logic is not evidence and biology is not always logical.
The more we look at breast milk and the more we find within it, the more we are driven to marvel that anybody can survive, much less thrive, on its wretched artificial substitute. Yet many have. The majority of baby boomers were reared exclusively on infant formula, and they're all around us, and are us, occupying space and every occupation. Today almost 40 percent of infants in this country are still bottle-fed from birth. Among babies in the United States who are breastfed to start, only half still receive breast milk at the age of six months. By a year, only 10 percent of babies still breastfeed. Researchers don't know what to make of it. They wonder if they are asking the wrong questions or neglecting subtle cues, or if it's simply a matter of general ignorance about growth and development, an ignorance reflected in scientists' inability to parse out and pin down all the deficiencies in bottle-fed babies. "As a scientist, I can't help but notice that millions of babies have never seen human milk, and they apparently have not been harmed," said Dr. Reeds. "At the same time, I can't escape the feeling that nature went to enormous lengths to produce a particular food, and that must mean something."
In Third World countries where breast milk may offer the only sterile fluid around, breastfeeding can be imperative to an infant's survival. In

 

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the developed world, the advantages of breastfeeding over bottle feeding are less obvious, but they exist. Breastfed infants have fewer infections of the middle ear, gastrointestinal tract, and upper respiratory system than bottle-fed babies do. They suffer less from diarrhea and constipation. When breastfed infants get sick, they recover sooner than those on formula do.
Of the many other benefits that have been ascribed to breastfeeding, though, not all have been proved. Breastfeeding supposedly helps prevent obesity later in childhood, but the evidence is equivocal, and complicated by socioeconomic factors. Breastfeeding is thought to lower the risk of allergies and asthma among children, yet the rates of chronic respiratory diseases have been climbing in recent years right along with an increase in breastfeeding. Some studies have suggested that breastfed children have higher IQs than their bottle-fed cohorts, but other studies that took maternal IQ into account found no connection between breast milk and intelligence. Perhaps the most questionable and philosophically disturbing benefit that has been pinned to breastfeeding is that it improves the emotional bond between mother and infant. Not only is such a bond impossible to quantify, but it pretty much sweeps aside all efforts to engage fathers as full and legitimate participants in child care. If it takes suckling to feel the most intimate and profound love for your baby, then a man with a bottle even one that holds expressed breast milk will always be as feeble a substitute for the well-teated mother as formula is for her milk.
Women know they should breastfeed their babies, and many are more than delighted to give it their best shot. But what is their best shot, and what of those who will not? In Scandinavia, it is considered tantamount to child abuse to feed an infant anything except human milk. Scandinavians have milk banks to supply milk when mothers can't or won't. In this country, fears of viral contamination have prevented the institution of a similar network of milk banks. Viruses, like the one that causes AIDS, can be transmitted through milk, and though it's possible to screen milk for the virus as blood is screened, the existence of a reasonable milk facsimile infant formula has kept down the demand for human milk that has been put through an expensive series of tests.
Breastfeeding is considered natural, an extension of pregnancy. The

 

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mammary gland is an extension of the placenta. All the products found in the placenta reappear in breast milk, including the immune factors, the growth factors, the hormones. Yet pregnancy takes care of itself; lactation doesn't. Pregnancy lasts 240 days. Suckling can last as briefly or as long as you please, or as it pleases others. Various authorities have sought to determine the true, basal human breastfeeding interval, but there is no such animal, and there probably never has been. The Koran advocates that a woman suckle her child for two years, but adds that if the husband and wife wish to wean the infant sooner they may do so, suggesting that many people in the past did so. The World Health Organization and UNICEF recently have recommended that women breastfeed for two years "and beyond," but only among contemporary hunter-gatherers like the !Kung, who nurse an average of 2.8 years per child, do we see much of that "beyond."
Nursing also is a learned behavior, and one that is not always easy to master. Great apes, whose milk is so compositionally similar to ours, must also learn by observing others the proper techniques for suckling their young, but humans are dunces compared to gorillas. We need tutoring from our obstetricians, midwives, and birthing instructors. We need lactation consultants and La Leche League crisis counselors. We have a hard time sitting still, and nursing requires patience and relaxation. Stress hormones can disrupt the flow of milk. Our nipples may crack and bleed from the pull of the infant's mouth, and though the pain is supposed to go away in a few days, for some it lasts much longer. Some women love breastfeeding their babies. They talk of how good it feels, how close to orgasm they come while nursing. They might be away from their baby, but the mere recollection of the sensation of suckling sends a warm rush across their body, and their milk starts to flow embarrassingly, if they are at work or in a meeting. They fall in love with their suckling infant and think of nothing and nobody else.
Other women never get the knack of joy. The baby cries and rejects the breast. The women keep at it, but they don't find their rhythm. Their milk never feels as though it's flowing. The baby gains weight slowly. Pediatricians are now questioning whether the fast weight gain seen in bottle-fed babies is the appropriate scale by which to measure natural growth patterns, but still, the baby seems perpetually hungry and the mother feels perpetually inadequate. She must go back to work,

 

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and she hasn't mastered breastfeeding, or breast pumping, or satisfying her baby or herself. She dislikes breastfeeding and she doesn't want to do it, but she feels guilty, bottomlessly guilty, at the thought of not nursing. She is not allowed to say how she feels. There are neuropeptides in milk, after all, and immune cells, and lactoferrin, and how could a mother ask her child to forgo the perfect food, the better part of herself? Maternal guilt is impossible to assuage. A female primatologist told me she blamed herself for her child's allergies, because she only breastfed the child for six months.
''The act of suckling a child, like a sexual act, may be tense, physically painful, charged with cultural feelings of inadequacy and guilt," wrote Adrienne Rich. "Or, like a sexual act, it can be a physically delicious, elementally soothing experience, filled with a tender sensuality."
Breastfeeding your baby is natural, yet women have long done otherwise, and sometimes it is hard to say whether they chose not to breastfeed or the choice was forced upon them. Wet-nursing is an ancient profession, and among the few open exclusively to women. Wet nurses were so common at certain times of history that they were subject to competition and had to advertise their services. In Renaissance Florence, groups of wet nurses gathered at markets and festivals and sang lacto-jingles: "Always when the baby cries/We feel our milk returning/Acting with energy and speed,/We do our duty." Expectant parents consulted how-to books on the traits to seek in a wet nurse. "The ideal wet nurse should be amiable, cheerful, lively and good-humored, with strong nerves; not fretful, peevish, quarrelsome, sad or timorous, and free from passions and worries," according to one treatise from sixteenth-century England. "Finally, a potential wet nurse must like children." Though for much of history only the wealthy could afford to hire wet nurses, as always the habits of the upper classes trickled down to the lower, and by the seventeenth century half or more of all women were sending their babies to other nipples for nourishment. High-priced wet nurses shipped their own babies off to cheaper wet nurses, to preserve their personal milk supply for professional use. In 1780, according to Marilyn Yalom, as few as 10 percent of all Parisian babies were nursed in their own homes.
Nor was wet-nursing the only alternative to maternal breastfeeding. We think of infant formula as a relatively new invention, another canker

 

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of advanced capitalism, but humans have long fed infants on the milk of other mammals, or on liquid gruel and pulverized adult food. Some anthropologists have suggested that dairy animals such as the cow and the goat were originally domesticated to provide milk for babies. The babies may have suckled directly from the animal's teats, or they were fed with weaning cups, or through cow horns, or through nipples fashioned from leather. Clay bottles shaped like breasts have been found at several sites in Europe that date from the late Neolithic era, around 3500
B.C.
Many of the infants fed on these substitutes for human milk died, either because they couldn't metabolize the cow's milk or because they contracted infections directly from the animals. According to church and county records of the eighteenth century, babies who were fed cow's milk through a cow's horn in certain parts of Germany and Scandinavia died of diarrhea at a much higher rate than infants in the same area who were breastfed. Nevertheless, the effort to circumvent breastfeeding, to shrug off the mammalian mantle, long predates Nestlé Corp., Ross Laboratories, and the formulas they hawk.
The question is, precisely who wished to avoid the lactational charge? In some cases, the husband demanded that his wife not breastfeed. Suckling ruined a beautiful bosom. A nursing breast was not his breast. He wanted her back to perform her wifely duties, that is, to sleep with him. Neither wives nor wet nurses were supposed to have intercourse while breastfeeding, for it was thought that breast milk was formed in the uterus from menstrual blood; medieval and Renaissance texts show a lacteal duct leading from the uterus to the breasts. Intercourse was thought to cause menstruation, which would then jeopardize or taint the flow of milk to the infant. There may also have been the observation that if a woman didn't breastfeed, she became pregnant again comparatively sooner. Men concerned with progeny and heirs wanted fruitful wives, and the less those wives lactated, the more they multiplied. By this calculation, the use of wet nurses in no way liberated women to possess themselves or pursue their fancies, but rather resulted in their spending that much more time pregnant.
Still, when political and medical tides turned and campaigns were initiated to encourage maternal breastfeeding, women, not men, were the target of the exhortations. In 1694, Mary Astell wrote
A Serious Proposal to the Ladies
, arguing that breastfeeding acted as a check on

 

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