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What a difference a word makes

July 31, 2009

Of all that I learned at the CAPPA lactation educator training workshop I attended last weekend, I was most intrigued by what I learned about the changing language of breastfeeding.

Perhaps not surprisingly, I was especially excited about the sorts of changes that could have a significant effect on women’s confidence in their ability to breastfeed and on their emotional and psychological connections to breastfeeding.

For example, many breastfeeding experts are now suggesting that the phrase “on demand feeding” should be replaced with “on cue feeding.” 

Notably, these phrases are each referring to the exact same practice: that is, offering the breast to the baby whenever s/he shows signs of hunger, as opposed to putting the baby on a rigid feeding schedule.  While there are sigificant differences between “on cue/on demand” and “on schedule” feeding, the only significant difference between “on demand feeding” and “on cue feeding” is the terminology.

Nonetheless, the terms themselves could have a profound effect on the way in which a mother approaches the nursing relationship with her child.  For one, to refer to a feeding as one that responds to an infant’s demands could exacerbate the already demanding aspects of caring for a newborn.  (“What?!  That kid is demanding me again?!”  As if there weren’t already enough being demanded of a new mother’s body!)

Moreover, waiting until an infant is actually demanding to be fed (e.g. by wailing in that ear-shattering way that my son M was so fond of as a newborn) means that one has missed the baby’s earlier feeding cues (e.g. sucking on the fist, or even just making a fist).  And once the baby is wailing (or “demanding”), getting a good latch is so much more difficult than when the baby is calmer and more alert. 

(Sometimes I wish my current self could go back to my new-mom self and say, “Hey, you!  See how that kid is chomping on his fist?  Put him on the boob now before he becomes a shrieking, squirmy breast-vampire!”)

In addition, I also learned that all the talk about waiting for a mom’s “milk to come in” in the first few days after the baby’s birth should be replaced with a discussion of how her “milk is transitioning” from colostrum to mature milk.  And as with the on-cue/on-demand shift, these two phrases refer to the exact same physiological process.  So the shift itself signals not a change in the facts but a change in the insinuations or even connotations of the terms.

To explain, what each phrase refers to is the maturation of the breastmilk in the days after birth.  In the first days after a baby’s birth, the baby receives nutrient and antibody-rich colostrum from his or her mother’s breast.  As the baby continues to nurse frequently and regularly–at least 8-12 times per 24-hour period–the milk matures, and the mother’s milk supply increases.  The mother’s body will continue to produce this “mature milk” until the child is completely weaned from the breast.

But at no point does mature milk actually “come in.  Instead, it transitions from colostrum to mature milk, a process that takes approximately one to two weeks to occur.

And just as referring to the infant’s feeding habits as “on cue” rather than “on demand” may have a significant effect on how the mother views the nursing relationship, referring to the early days of breastfeeding as ones in which her milk “transitions” rather than “comes in” may have similarly significant effects. 

And this is because many woman are made to feel inadequate or even unable to nurse their babies because their milk supply supposedly did not “come in.” 

But this is an absolutely misleading statement.  If the mother’s body is producing colostrum–and it will months before the baby’s birth–then her milk has come in.  It just needs to 1) transition from colostrum to mature milk and 2) increase in supply.  And if the mother’s milk supply is low, then the mother can and should take steps to facilitate the maturation process and increase her milk supply–not to feel inadequate about her body and it’s abilities and/or to resort to supplemental feeding simply because her milk hasn’t “come in.”

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