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Welcome to the July 2010 Carnival of Nursing in Public This post was written for inclusion in the Carnival of Nursing in PublicNursingFreedom.org. All week, July 5-9, we will be featuring articles and posts about nursing in public (“NIP”). See the bottom of this post for more information. ***
Nursing in public is controversial in today’s Jewish world. A guest post I wrote on a liberal Orthodox Jewish blog, advocating acceptance for woman nursing in the women’s section of the synagogue, drew hundreds of mostly negative comments. But there is no evidence that Jewish texts and tradition prohibit breastfeeding in public. And rabbis never viewed breastfeeding as too “unholy” for the synagogue.
A Jewish discussion of nursing in public usually centers on two possibly conflicting values. Judaism recognizes the importance of breastfeeding in nurturing children, with the mother as the primary spiritual influence in the early years. Yet Jewish law requires women to dress modestly, and that includes keeping breasts covered.
My cousin is writing a doctoral thesis on the history of Jewish women’s dress. She explained that Jews usually adopted clothing styles of the surrounding culture, making changes when necessary. For example, Jewish women living in societies where uncovered breasts were the norm covered theirs. In Judaism, breasts have a dual role—they feed and nurture children, but they are also erotic.
Two biblical stories shed light on a Jewish approach to breastfeeding. Baby Moses, hidden so he wouldn’t be killed by Pharaoh’s evil decree, was placed in a basket on the Nile. His sister stood by to make sure he would be safe. When Pharaoh’s daughter rescued Moses, she sent for a wet nurse from the Hebrew slaves. According to the Midrash, an early compilation of rabbinic interpretations of Exodus, Moses refused to nurse from an Egyptian wet nurse. The leader of the Jewish people was nursed only by his own mother. In Judaism nursing is more than food—it plays a key role in transmitting religion, values and culture. Hannah also nursed her son, Samuel, for several years before sending him to study under Eil and fulfill his life’s mission as a prophet (I Samuel, Ch. 2). Rabbinic texts define the nursing period from between two to four or five years old.
Does the fact that breasts are seen as erotic mean that breastfeeding is erotic as well, and should be private even when the breasts are not visible? In Jewish texts, a discussion of women’s modesty centers around whether a man can pray in the presence of a woman with various body parts exposed. According to the Ben Ish Hai, a rabbi from the late 18th century in Baghdad, while a woman is breastfeeding her exposed breasts are not considered erotic. The function of the breasts, feeding a baby, trumps considerations of modesty. But the fact remains that even though Orthodox women are careful to cover up when nursing, they are often made to feel uncomfortable.
I saw a woman in a black robe down to her ankles calmly nursing her baby on a bench in a Jerusalem zoo. I’ve also met women comfortable showing cleavage or a bare midriff, but not with nursing in public. Whether one nurses in public has little to do with religion or modesty. Modern Jewish expressions of discomfort with public breastfeeding come from the un-Jewish attitude of the surrounding bottle-feeding culture.
All of the reasons for protecting the rights of women to nurse their babies wherever they are—convenience, social involvement, better breastfeeding rates– remain valid for traditional Jews, especially mothers of large families. It saddens me that society’s negative attitudes toward breastfeeding in public could influence young Jewish mothers to avoid breastfeeding.
**Welcome to the Carnival of Nursing in Public
Please join us all week, July 5-9, as we celebrate and support breastfeeding mothers. And visit NursingFreedom.org any time to connect with other breastfeeding supporters, learn more about your legal right to nurse in public, and read (and contribute!) articles about breastfeeding and N.I.P.
Do you support breastfeeding in public? Grab this badge for your blog or website to show your support and encourage others to educate themselves about the benefits of breastfeeding and the rights of breastfeeding mothers and children.
This post is just one of many being featured as part of the Carnival of Nursing in Public. Please visit our other writers each day of the Carnival. Click on the links below to see each day’s posts – new articles will be posted on the following days:
July 5 – Making Breastfeeding the Norm: Creating a Culture of Breastfeeding in a Hyper-Sexualized World
July 7 – Creating a Supportive Network: Your Stories and Celebrations of N.I.P.
July 8 – Breastfeeding: International and Religious Perspectives
July 9 – Your Legal Right to Nurse in Public, and How to Respond to Anyone Who Questions It
A new Israeli study making the rounds of the internet is claiming that exclusive breastfeeding, instead of preventing allergies as has been shown by countless earlier studies, actually increases the risk for dairy allergy. At the end of the article, the researchers ignore recommendations by the World Health Organization and other medical bodies in place for decades, advising parents to give their babies cow’s milk in the early days and weeks of life.
Dr. Yitzhak Katz, lead researcher of the study, was interviewed by the press:
Katz added that the findings should not be interpreted as discouraging breastfeeding. Rather, he recommends simply complementing it with cow’s milk early on.
“Let Dad enjoy some midnight infant bonding,” he said, “while he delivers a dose or two of cow’s milk protein.”
Dr.Sharron Bransburg Zabary, an International Board Certified Lactation Consultant and researcher in the field of the immune system at Tel Aviv University, read and responded to the study. In an article on the Israeli site Walla, she points out flaws in the study’s data and methodology, and explains why its conclusions were so irresponsible.
The article looked at 13,000 births and analyzed data regarding the introduction of cow’s milk formula and subsequent dairy allergy. The data showed that only 0.5% of babies are allergic to cow’s milk, a much lower number than the one to three percent allergy rate reported in medical literature.
Below is my summary of Zabary’s main points:
Zabary concludes:
The researchers chose to ignore these dangers and recommend, in an irresponsible way, early exposure to cow’s milk that can damage babies’ health of babies. They chose to directly influence the public, in an indefensible way, by bypassing instructions of the health ministry entrusted with public health (perhaps knowing that the study would not pass this test) and whose dietary recommendations for infants contradict the study’s conclusions.
The cynical use researchers made of children’s health should concern health authorities in Israel. The study was funded by the “milk council” and one can only ask whether this study was motivated by financial interests. Is the health of our children up for grabs? Because it can’t be that a lone study concerned with only one risk with a very low incidence will lead to a harmful change in the way babies are fed.
Zabary mentioned that she reads dozens of articles about breastfeeding and the immune system each month, yet only negative studies about breastfeeding get so much press.
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Breast Cancer and Breastfeeding: What if Women Didn’t Have Breasts?
Breastfeeding and Hormonal Birth Control
Gina Weissman, DMD, IBCLC
The rate of cosmetic breast surgery is growing rapidly in Israel and abroad. But young women and teenagers don’t always consider the impact their surgery will have on breastfeeding. Even though women are often told differently, all types of breast surgery can affect breastfeeding.
At the La Leche League Israel Conference in June, 2009 at Tel Hashomer Hospital/Sheba Medical Center, Gina Weissman, International Board Certified Lactation Consultant/Doctor of Dental Medicine/La Leche League Leader, spoke on the growing rate of cosmetic breast surgeries in Israel. She looked at the impact on breastfeeding of the latest methods of surgery, and gave guidelines for breastfeeding professionals working with mothers with a surgical history. Gina graciously agreed to answer my questions by phone and email.
For more information, see Gina Weissman’s website (Hebrew).
What got you interested in the topic? In the last 5 or 6 years I have seen a huge rise in the number of women with past surgeries. They didn’t even bring it up until I noticed something unusual and asked about it. They would say, “Oh yeah, but my doctor said it would have no effect,” or “Oh, that was years ago.” Some were worried their husbands would find out. These women had breastfeeding issues, and I felt I that in order to help them, I needed to learn more about the effect of cosmetic surgery on breastfeeding.
The two main types of cosmetic surgery on breasts are reduction and enlargement. Breast reduction has benefits for women, including reduction of breast pain and back problems, and patients report a high level of satisfaction compared to other cosmetic procedures. Most of the increase in recent years is in the number of operations to enlarge the breasts, as much as 700% over a two-year period.
Most of the focus on breast surgery and breastfeeding has been on reduction. Diana West has a website and a book on the subject. Women who choose to enlarge their breasts assume they will be able to breastfeed. Breast enlargement is less of a problem, but it does affect breastfeeding.
How did you prepare for the lecture?
I turned to the company providing malpractice insurance for plastic surgery to get statistics for 2005 to 2009. The statistics are important, but I also wanted to know what is behind the scars. I spoke to plastic surgeons and read a textbook. One surgeon said, “After you’ve read it, you can come to see surgery.” I looked at what this poor boob has to go through, whether enlargement or reduction. In a third type of surgery, the breast lift or mastopexy, the nipple is moved upward. The scars and tissue removal are similar to reduction. Skin under the nipple and areola are cut off.
I also talked to mothers struggling, and followed up with mothers I had counseled.
Are silicone implants still used for breast enhancement? Are they dangerous?
Silicon is very popular all over world, and is considered safe. Saline is a more benign option, but considered less aesthetic. They feel different and both must be removed in case of leakage.
Complications:
Implants are often replaced because of ruptures or changes caused by gravity. Most often, though, the woman decides to change the look.
The most common complications are hematoma and capsular contractures, when the body makes a stiff shell over the implant. The implant must be removed. More nerves are cut, causing further problems for breastfeeding later on. In a 2003 study, the mean time for all revisions, whatever the reason, is seven years.
Placing the implant under the muscle reduces the risk of capsular contracture and may slightly reduce the risk of breast cancer. No evidence indicates that silicone implants increase the risk of breast cancer.
What factors determine whether a mother with a history of cosmetic breast surgery will breastfeed successfully?
What techniques help a mother with past surgery maximize supply?
If a young woman or teenager considering cosmetic breast surgery approached you on the subject, how would you advise her?
Is there anything you would like to add?
Yes. Breastfeeding is not just about milk, it’s about the relationship. Today I Spoke to mother on motilium, a medication used to increase milk supply. She was making hardly any milk, maybe 1-2 cc. at the feeding. But the mother is using a supplemental nursing system (SNS) to feed formula while he is also nursing at the breast. So it’s hard to know exactly how much milk he is taking. Recently,she took a medication containing chlorophyll. She was excited that the baby’s stools turned green, because it showed that he is getting a significant quantity of her milk.
You may also enjoy:
Breastfeeding the Late Pre-Term Baby
More Breastfeeding Posts by A Mother in Israel
Breastfeeding and the Working Mother
Miracles of Motherhood: Breastfeeding the Premature Baby after Breast Reduction
Marjorie Ingall wrote an article in Tablet Magazine called Bottled Guilt, where she argues that Jewish women are set up to feel guilty when breastfeeding doesn’t work out. The desire to raise intelligent and healthy children is entrenched in our genes, and for most of us successful breastfeeding is our first parenting goal. The only Jewish women I have met who (admitted that they) did not intend to breastfeed either had medical contraindications or were traumatized by their first experience.
I think another reason modern Jewish women are predisposed to breastfeed is that Jews in the Diaspora are used to going against the grain of popular culture.
I completely agree with Ingall’s point that mothers aren’t usually at fault when breastfeeding fails. She writes, “. . . it’s unfortunate that women are guilted for not nursing when a big chunk of blame should fall on our culture.” She blames limited maternity leave, but that is only one factor. Often it is the mother who is trying the hardest and wants it most, but she gets insufficient support from the hospital, pediatrician, and family.
Ingall devotes a long paragraph to unhelpful remarks made to struggling mothers:
My sister-in-law, struggling to nurse twins, called the La Leche League, an international breastfeeding support group, for help. The woman on the phone told her, “Breast milk is like a blood transfusion for a baby. Formula is like a hot dog and fries.”
La Leche League Leaders are trained not to speak disparagingly about formula. It’s counter-productive, and Ingall is right to call out that Leader. I hope Ingall’s example won’t stop anyone from approaching LLL’s volunteers for free, high-level help.
A good friend of mine was told in disbelief by another mom, “Your kids seem healthy and smart, and they weren’t breastfed!” (My friend pointed out that actually, two of her four children had nursed a bit. The woman smiled and said, “Oh, but you cheated with formula, right?”)
Who cares? People say all kinds of stupid things.
Another friend called a lactation consultant, sobbing, worried that her newborn daughter (who was born with a pinched nerve in her neck, leaving her unable to nurse) was starving on the meager amounts of breast milk she was able to pump and feed through a tube. The lactation consultant urged my friend not to give her hungry baby formula. “It’s like feeding her poison,” the consultant said in a hushed voice. “It will damage her kidneys and take three months to get out of her system.” My friend worked herself into a frenzy, pumping every two hours, waking the baby constantly to get her to eat, crying regularly.
As I said above, breastfeeding helpers shouldn’t bash formula which is a necessity for some babies. If Ingall is reporting accurately and the baby was only receiving “meager” amounts of milk, the lactation consultant is negligent or worse. Rule #1 is “Feed the baby.” Ingall is right to call out this one too.
Still, I object to Ingall’s implication that formula isn’t so bad and that people make too big a deal out of it (“recent research showing that formula isn’t poison”). She is making a judgment just like the breastfeeding helpers she quoted, but with less authority. And it’s one-sided to give examples of unprofessional advice by breastfeeding advocates while ignoring misinformation and advice by pediatricians and hospital staff, whose voice carries more weight. Moms I talk to are regularly told that there is no such thing as thrush, they should give a bottle to tide the baby over till the milk comes in, they need to wean for breast infections or jaundice, their baby is too old to nurse, and that it’s fine for a breastfeeding newborn to have a bowel movement once every few days (it’s not).
Ingall quotes LLL Leader and expert on insufficient milk supply Lisa Marasco, who describes some medical conditions related to low milk supply. This is valuable information. Then Ingall adds her own examples:
Postpartum depression or stress can certainly be factors too, and nagging doesn’t help. We’ve all had friends who tried to nurse exclusively, but wound up in a sobbing heap on the bedroom floor at 5 a.m., sending their partners out for formula. Finally, if a baby latches improperly, over the long term he or she may not get enough milk and nursing will hurt the mother like a mofo. Lactation consultants may be able to help. Or not.
I guess Ingall is trying to comfort mothers who feel bad because breastfeeding didn’t work out, and perhaps this will work. But her cutesy remarks won’t help future mothers.
I wish mothers didn’t retain guilt feelings about past weaning. I advise mothers who regret having weaned to talk it out, forgive themselves, resolve to learn more for next time, and move on. Guilt interferes with effective parenting.
The bottom line is that mothers make the best decisions they can based on the resources available to them at a stressful time. We should avoid judging mothers. Instead, we should work to make sure that all parents receive objective, accurate information and as much support as they need. Let’s empower parents to make decisions that are right for their families.
If you like this post you might also enjoy:
No, Emuna, There Are No Lactation Police
Sex vs. Breastfeeding: Response to Rabbi Boteach’s Misguided Weaning Advice
Baila posts an interview with her friend, Nitsana Bellesohn, who directed a short film to call attention to the fight against breast cancer. Entitled “FLAT,” it’s up for the Amazing Grace Award. Warning: The film contains images of exposed breasts.
Go here to see all the films and vote for your favorites.
The film asks the question: What would the world be like if women didn’t have breasts, and children had to go to a museum to see them? What if breast cancer became so prevalent that girls began taking hormones to keep their breasts from growing?
Unfortunately, the film views breasts, and by extension women, as sex objects for men. Most of the film’s footage shows men ogling breasts and recalling to their young sons how pleasurable it was to watch and hold breasts.
I am not sure what hyper-sexualization of breasts has to do with breast cancer. Breasts are part of women’s bodies and are biologically intended for feeding and nurturing babies, not for titillating men.
Girls don’t even appear in this film, unless you count the token woman who rolls her eyes at the men’s reaction to the “artwork.” Women’s feelings about the existence of this museum are never addressed.
Is reminding men that they might lose their playthings, as it were, the only way to get them interested in breast cancer? What a shallow portrayal of men. What a sad commentary on our culture’s attitude toward women’s bodies.
I would have stopped here if the film hadn’t mentioned breastfeeding at all. But since it did, I’ll add some thoughts on breasts, infant feeding, and cancer.
The film’s only indication that breasts have a biological function is when a boy comments on a picture of a baby breastfeeding. His father tells him, matter-of-factly, that that was how babies used to eat. The son says, “Gross.” I think the idea is that boys think breasts are gross because they have never seen them. Although breasts are visible everywhere today, selling products, plenty of people still find breastfeeding disgusting. Just look at any debate about public breastfeeding. The son’s reaction did not seem futuristic to me.
In the film, the environment is blamed for the increase in breast cancer rates. But what about the connection between breastfeeding and breast cancer? According to a collaborative reanalysis of individual data from 47 epidemiological studies in 30 countries, reduced breastfeeding rates are an important factor in breast cancer rates:
It is estimated that the cumulative incidence of breast cancer in developed countries would be reduced by more than half, from 6.3 to 2.7 per 100 women by age 70, if women had the average number of births and lifetime duration of breastfeeding that had been prevalent in developing countries until recently. Breastfeeding could account for almost two-thirds of this estimated reduction in breast cancer incidence. INTERPRETATION: The longer women breast feed the more they are protected against breast cancer. The lack of or short lifetime duration of breastfeeding typical of women in developed countries makes a major contribution to the high incidence of breast cancer in these countries.
Not every discussion of breast cancer needs to mention breastfeeding. But the film’s approach was disturbing because society’s attitude toward breasts affects breastfeeding rates, and therefore cancer rates. When breasts are associated with women, mothers and babies, more women choose to breastfeed and their partners will support them. I’m not denying the importance of breasts in sexual pleasure, and there are many factors that contribute to lack of breastfeeding. But until we stop seeing breasts as the object of men’s desire instead of as a way to feed and nurture babies, breastfeeding rates will remain low.
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