Fourth Edition Nursing Your BABY Karen Pryor and Gale Pryor To Max, Gwen, Wylie, Ellie, Micaela, Nathaniel, and Maile, all breastfed babies Contents Disclaimer Preface to the Fourth Edition x Part I: The Science and History of Breastfeeding 1 1 The Nursing Couple 3 2 How the Breasts Function 21 3 Human Milk 64 4 How the Baby Functions: The Body 121 5 How the Baby Functions: Behavior 145 6 A Parent Is Born: The Innate Behavior of Caretaking 171 7 Helpers and Hinderers: How Breastfeeding Was Saved, and Why the Job Is Not Yet Done 192 Part II: The Art of Breastfeeding 215 8 Before the Baby Comes: Preparing to Breastfeed 217 9 In the Hospital 245 vi Contents 10 One to Six Weeks: The Learning Period 275 11 The Reward Period Begins 316 12 The Working Mother: How Breastfeeding Can Help 362 13 Nursing Your Older Baby 391 References 407 Resources: Sources of Breastfeeding Information and Supplies 437 Sample Letter to Human Resources Department 440 Index 443 Acknowledgments About the Authors Also by the Authors Credits Cover Copyright About the Publisher Disclaimer This book contains advice and information relating to health care. It is not intended to replace medical advice and should be used to supplement rather than replace regular care by your doctor. It is rec- ommended that you seek your physician’s advice before embarking on any medical program or treatment. All efforts have been made to ensure the accuracy of the informa- tion contained in this book as of the date published. The authors and the publisher expressly disclaim responsibility for any adverse effects arising from the use or application of the information con- tained herein. Preface to the Fourth Edition I have grown up with this book. At eight, I read Nursing Your Baby cover to cover, not because I was fascinated by breastfeeding, but because so much of my mother, Karen Pryor, could be found in its pages. The mother herself was right there beside me, driving me and my brothers to school, getting dinner on the table, managing a busy household and career. But her mind—her unique blending of biology, anthropology, sociology, and everyday mothering— was explained to me in her readable writer’s voice on the pages of Nursing Your Baby. It shaped, in turn, my mind, my writing, and my mothering. Her ability to communicate the value of breastfeeding to her peers in her writing and lectures was one of the lifelines that saved breastfeeding. Nearly eradicated in the United States by the 1960s when just 18 percent of babies were breastfed, a few dedicated women, my mother among them, coaxed the art of breastfeeding back into our culture. For nursing is an art, and one best taught woman to woman, one mother and baby at a time. Perhaps that is why Nursing Your Baby, written by a mother for other mothers, has endured for more than forty years. This book’s gift is the confidence it instills in women that they can nurse their babies. It has assured two generations of women ix Preface to the Fourth Edition that not only does breastfeeding matter a great deal, but so do they. With confidence gained through successfully breastfeeding their babies against the odds, thousands of women have gone on to devote their lives to helping other mothers do the same. They formed La Leche League International and established the new medical profession of certified lactation consultants. They’ve or- ganized, legislated, protested, campaigned, and written articles and more books. Thanks to their work, and that of the research scientists drawn by the fascination of lactation, it is at last well known and widely accepted that “breast is best.” Even so, the majority of American babies are weaned within a few months. Why? The United States is still not a very friendly place for mothers and babies. Breastfeeding beyond the newborn period requires more than knowing how to put a baby to the breast; it asks for a culture that supports a mother and baby as a couple. Culture is a pervasive thing, and we are not always aware of its influence in our individual lives. It can be found in a neigh- bor’s advice, a medical opinion, a television commercial, a hu- man resources department, a magazine article, or a Hollywood movie. Despite the resurgence of breastfeeding in recent decades, the overwhelming majority of cultural messages given new moth- ers are that bottlefeeding is the rule and breastfeeding the excep- tion, that mothers who work (as most do) cannot also breastfeed, and that nursing, at least for a few weeks, is an obligation rather than a source of satisfaction and joy. None of these beliefs is true, and all interfere with successful breastfeeding. With each new edition of Nursing Your Baby, my mother and I are surprised by how much work still needs to be done to support mothers and babies, how many obstacles remain for women who wish to blend the pleasure of mothering, beginning with breast- feeding, with the rest of their active twenty-first-century lives. Now, with the fourth edition, we are gratified to witness the Preface to the Fourth Edition x progress of breastfeeding over the last decade. So much has changed for the better. In many ways, however, our increased un- derstanding of the mechanisms and benefits of breastfeeding has also broadened our mission in giving mothers and babies the best start possible. Now we know that we need to take better care of mothers, so that they may take better care of their babies. Since the last edition of Nursing Your Baby, Karen has moved on to new adventures, including writing and lecturing about the art of positive reinforcement teaching, called clicker training or TAG teaching, to groups as various as animal trainers, gymnastics instructors, and special education teachers. Once in a while, someone will come up to her at a conference to ask if she is the same Karen Pryor who wrote Nursing Your Baby. The question al- ways comes from a nursing mother, another woman for whom breastfeeding was the blueprint for a new positive, mutually ben- eficial way of interacting with others, whether a child, a dog, or a student, without punishment or coercion. They see immediately that the mission Karen is on now is not very different from her work as a breastfeeding advocate. A science writer by trade, I too find the lessons of nursing my three sons have lasted long past the day my youngest weaned him- self. A fascination with the biology and behavior of parenting and the amazing capabilities of infants was sparked by breastfeeding, and has developed into a writing specialty. It has been a privilege to replenish Nursing Your Baby with the rich research and new knowl- edge about lactation that has emerged since the last edition—and to provide a new generation of mothers with its unique blend of science and warmth, and its gift of confidence and joy. Gale Pryor Belmont, Massachusetts January 2005 Part One The Science and History of Breastfeeding 1 The Nursing Couple he oneness of the nursing mother and her baby has always fas- Tcinated mankind. Like lovers, they are united both physically and spiritually. Unlike lovers, their union lacks the ambivalence and tensions of sexuality. The Egyptians portrayed their chief god- dess, Isis, with the infant Horus at her breast. Christianity reveres the Madonna, the image of mother and infant, as a symbol of pure love. The Dalai Lama, spiritual leader of Tibetan Buddhism, speaks of compassion and altruism as first learned at a mother’s breast, as the mother gives of herself to her child. Artists through history and across geography have been inspired by the nursing couple to convey, in stone and clay and paint, two souls who are one. It is brief, this unity. In most cultures, the baby is weaned in a year or two—or much less—and his world expands beyond his mother’s arms. She then becomes a part of her child’s life, sharing its center more each day with other people, other interests, even- tually yielding her place of primacy entirely. Yet for all its brevity, the nursing couple is an intense relationship. Mother and child share a rapport so complete that it can exert a profound effect on both. Without this rapport, this mutuality, breastfeeding may cease. Nursing a baby is as much about the giving and taking of self as it is about the giving and taking of milk. 4 The Science and History of Breastfeeding Nursing a baby is an art; a domestic art, perhaps, but one that, like cooking and gardening, brings to a woman the release and satisfaction only creative work can give. The author Anne Mor- row Lindbergh wrote, “When I cannot write a poem, I bake bis- cuits and feel just as pleased.” Nursing gives the same sort of satisfaction and joy. Successful nursing mothers tend to feel that breastfeeding is special, and are thankful for the experience. Breastfeeding is special for the baby, too. While drinking from a bottle is a passive experience, nursing at the breast is a partici- pation sport. Babies can throw themselves into it with an endear- ing, almost comical gusto. British novelist Angela Thirkell offers an observation of a grandmother watching her daughter nursing her new baby: “Edith was sitting in a low chair, her baby in her arms, while the said baby imbibed from nature’s fount with quite horrible greed. Her face became bright red, a few dark hairs were dank with perspiration, one starfish hand was clenched on a bit of her nightgown..