Thursday, 24 January 2008

Normative Nursing: Donovan/Dettwyler Article

This is such an astoundingly good article on normal nursing patterns, I thought I'd archive it here in its entirety. The original article is difficult to read through, as it's split across many pages, and links die eventually anyway. So, in order to keep this one in one place... and forever..
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Extended Nursing - The Human Norm

by Debbi Donovan, IBCLC
A personal interview with Katherine Dettwyler, Ph.D.

When we talk about weaning a baby, how much emphasis do you think the mother's feelings should play into this? In other words, if baby is willing, but mom is really tired of breastfeeding, how should those two things be reconciled?

I do think that mother's feelings should play a role. I don't think anyone should feel they have to martyr themselves and continue to nurse past when they are willing to do so. But the important thing is for the mother to have full and complete information about what is the normal duration of breastfeeding for human children. This would include an understanding of why her child still wants to nurse (i.e. it's not just a habit, nor is the baby being demanding and manipulative just because it is acting like a human naturally/normally would act in wanting/expecting to nurse for many years), and the potential consequences of weaning prematurely (in terms of mother's health, child physical health, child's emotional health, etc.)

I think that a lot of women wean "early" simply because their doctor told them to, or told them all the health benefits were gone, or told them they were doing it only for their own pleasure. I have no problem with any decision any mother makes from a position of full and complete knowledge of what is normal and natural for humans and what the consequences may be of weaning at that age. I don't personally care if women breastfeed for any length of time. I do object to people making decisions based on faulty information, incomplete information, etc.
Recently, I was chatting on the phone with Dr. Walter Evans, M.D., from Dallas Presbyterian Hospital, about my research suggesting a natural age of weaning between 2.5 years and 7.0 years. He said "Don't you think it would be too daunting if we told new mothers that they had to nurse for 2.5 years, as a minimum?" I responded, "First, I'm not suggesting anyone tell mothers they have to nurse for any duration of time. I'm just suggesting doctors tell them that 2.5 years seems to be the minimum natural age of weaning/the minimum duration the child has been designed to expect. Second, if you know that a certain length of time is normal for a particular activity, then you just accept it -- it doesn't seem daunting.
No one thinks it is too daunting to tell women they must be pregnant for 9 months in order to have a healthy baby. We all know that human pregnancies last 9 months, and if you want a healthy baby, you have to be pregnant for 9 months. And while some babies survive who don't stay in the womb for the whole 9 months, they often require special medical care and many end up with permanent disabilities to varying degrees. Few, if any, women, would risk the potential damage to their baby and insist on an induction at 6 months of pregnancy because they found it too daunting to be pregnant for the whole 9 months, and were only willing to be pregnant for 6 months.
To get back to the real heart of your question, however, if the mother is uncomfortable with continued nursing, and the child is say well past the age of 3 years, then I see nothing wrong with basing the weaning decision more on the mother's feelings. After all, I weaned my youngest at 5.5 years, even though he would have been willing to continue nursing longer. I'd had enough. The older the child, and the cleaner his environment, the fewer diseases, the better access to medical care, etc., the less critical the remaining duration of nursing (if we choose 7 years as the upper limit).
I think if you look at other animals, the mother usually (though not always) weans the current offspring when the next offspring/litter is on its way. If there is no next offspring/litter, then they often let the current offspring nurse much longer. Our wild mustangs are still nursing their two year olds, though yesterday one of them kept stepping away when the "baby" (bigger than mom!) tried to nurse. The baby was persistent and the mom finally gave up and let her nurse. In the wild, these moms would have had second offspring one year after the first, and would have third offspring this year, so I'm sure they wouldn't still be nursing two-year-olds. Humans are probably supposed to have a six to eight year birth spacing between births -- you achieve this by frequent nursing due to lack of suitable other foods in the environment for young children and low body fat on the mother due to low-fat diets and high physical activity. Once humans began cooking food (500,000-900,000 years ago) and domesticating grain crops that could be cooked (6,000-10,000 years ago), however, you got a whole lot more foods that young children could eat to replace the nutritional function of breastmilk in the diet. And you got better nutritional status for the moms, too, so that it became feasible to nurse children for only 3 to 5 years, and then have another baby.
Obviously we live in a culture that finds breastfeeding beyond a year to be an oddity. Are there psychological consequences for the mother or child to consider when "going against society's grain" in such a way?

Not that I am aware of. Children (and even adults) tend to think that the way they live is "normal and natural and what everybody does." My youngest Alex knows lots of children who nurse as long as he did, or longer, and just assumes that all the kids in his daycare/kindergarten are nursing to sleep at night. He is aware that some babies aren't lucky, and don't get to nurse at all. He is aware that advertisers use breasts to sell beer and lingerie and other items.

I would say that the "cognitive dissonance" children might experience when they find out that not everyone gets to nurse as long as they did is similar to that they experience when they first run across racism or sexism or classism or religious intolerance, if they've been raised to be non-racist, non-sexist, non-classist, and religiously tolerant. The fact that we live in a racist society does not mean that I must give in to it and teach my children that racism is fine. The fact that we live in a sexist society does not mean that I must give in to it and teach my children that sexism is fine. And so on. I firmly believe in taking a stance for what I believe to be right. I teach my children to not be racist, not be sexist, not be classist, to respect everyone's religious beliefs (even those who don't respect ours), and so on. I teach them that breastfeeding until six to seven years is normal and natural, and to pity those children who never get to breastfeed.
We all know that there are moms of toddlers who are "closet nursers." How important is it that they step out? Or is it?
I think it is too much to ask people who are currently nursing toddlers or older children to take the risk of stepping out, given that the consequences can be so devastating -- children taken away by Department of Child Protective Services, or whatever it is called in your state, parents accused of sexual abuse, etc. I think it is important for people who nursed their children for a long time to speak out, once their children are grown. They are at no risk then, as their kids are grown and on their own. They could serve as powerful role models, and as a much clearer indicator of how common this really is.
How much experience have you had talking with people who have memories of nursing as young children?
Very little. The few I have met remember nursing fondly. My own Miranda (17 years old now) claims not to really remember nursing, even though she nursed until 4 years of age. I think most people's clear memories don't begin until between 4 and 6 years of age.
As to the health benefits of nursing beyond the first year, how often must a toddler nurse to see measurable benefits?
No one has studied the question in this particular way. The research that looks at duration of breastfeeding usually divides the duration into six month categories: birth-6 months; 6-12 months; 12-18 months; and 18-24+ months. That last category may include children who have nursed for many, many months/years.
All of the research done this way shows steadily increasing benefits the longer you breastfeed, including higher IQ scores and school grades. The research on health benefits to the mother shows increasing benefits the longer she breastfeeds in terms of breast cancer risk.
Despite this research, it no doubt comes as a shock to people to find out that there are very real health benefits to nursing a toddler. How significant are the health benefits?
That depends -- it depends on the child's genetic predisposition to diseases, and their exposure to diseases in their environment. It depends on their genetic makeup for other things as well. There are many diseases which have a genetic component as well as an environmental trigger -- if you don't have the genetic predisposition, then it may make no difference at all if you were breastfed or bottle-fed. The problem is that the parents have no clue if their child has a genetic predisposition to diabetes, say, or schizophrenia, or multiple sclerosis, heart disease, breast cancer, allergies/asthma etc. etc. etc.
So, you can't say that there is any simple answer to the question of how significant are the health benefits. To some children, they may be miniscule, but to others they may be a matter of life and death. All children, though, were designed to expect breastfeeding for a minimum of 2.5 years, according to my research.
What is your suggestion to a person who finds themselves facing unsupportive family and friends when they are still nursing?

Hand them a copy of my chapter "A Time to Wean" or any of the many medical journal articles I cite showing increasing health benefits the longer you nurse. They can tell unsupportive family and friends that they have read the research, found out about the consequences of premature weaning, found out what is the normal/natural duration of breastfeeding in humans, and they are:

1) doing what is best for their child's physical health, cognitive development, and emotional health,
2) doing what is best for their own health and
3) doing what is normal and natural for humans to do.

When we talk about child-led weaning, what do we mean? What role does the mother play in the process?

True child led weaning means that the mother nurses the child whenever the child indicates a need/desire to nurse -- whatever sorts of cues the child uses, whether it is a tiny baby mouthing its fist and arching its back and searching for the nipple with its mouth, or an older child asking "Can I nurse now, mommy?" I think that many moms claim to be practicing child-led weaning when they really are sending multiple signals to the child that they don't want to nurse the child any more. For example, placing lots of limitations on when and where the child can nurse, distracting the child, asking them to wait until mom gets off the phone, finishes cooking dinner, finishes folding laundry, or whatever. I think children can pick up on the negative vibrations that a mother sends out who doesn't want to be nursing. La Leche League's idea of child-led weaning is summed up in their advice "Don't offer, don't refuse." In other words, you always let the child nurse when he/she asks, but you don't say "Do you want to nurse?" to the child who hasn't indicated an interest.
Katherine A. Dettwyler, Ph.D., is an Associate Professor of Anthropology and member of the Faculty of Nutrition at Texas A&M University in College Station, Texas. She is the author of Dancing Skeletons: Life and Death in West Africa, and the co-editor, with Patricia Stuart-Macadam, of Breastfeeding: Biocultural Perspectives. Her research focuses on cultural beliefs and practices surrounding infant and child feeding and their consequences for child growth and health. She is also interested in the evolutionary blueprint for breastfeeding and weaning behavior in modern humans. She lives on 18 acres of east Texas oak prairie with her husband, her three children, 4 horses, 3 dogs, 4 cats, and 3 guinea fowl.


Jane said...

Fabulous article, Morgan - really thought-provoking. If I may, I'll link to it on your site when I finally get round to finishing the extended nursing article I'm halfway through?

Morgan said...

Of course! And that's why it's here - to keep it usable and findable for all. :-)