The Milky Way: Doulas and Breastfeeding Support

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This is a longer version of a chapter in my book Why Doulas Matter, published by Pinter and Martin

“Some doulas may know absolutely nothing about breastfeeding. Yet they have a magic way of creating a relaxed circle around the mother. They can project an air of security and supportiveness within which the mother feels free. They make it easy for her to give herself without fear to the relationship and the job of feeding. That’s all some mothers need.”

That quote is taken from a book called The Tender Gift: Breastfeeding, by Dana Raphael, published in 1973. It was in this book that we find the first use of the term ‘doula’. Dana was an anthropologist exploring the traditional practice, in some cultures, of new mothers being accompanied and supported through the initiation of breastfeeding by lay women from outside the mother’s family. Dana always attested that the word doula came from the ancient Greek, meaning ‘female servant’ and that she’d found the reference in Aristotle. Here’s what Dana thought about female companionship and support during birth and breastfeeding:

“When a bottle-nosed dolphin gives birth to a calf, other adult females in the group help out by keeping her offspring afloat until he can fend for himself or until the mother regains her strength…these acts of caretaking increase the survival chances of that herd…in the case of human mothers, those who have some sort of “mothering” from another person do well at breastfeeding, but those who do not can almost certainly expect trouble.”

Whatever the origin of the term, I think it is good to remember that our roots are in supporting mothers to feed their babies. This thread in our work is important and powerful. And it is undeniable that we make a difference to the mothers, however they end up feeding their babies. The last Doula UK survey in 2014 found that:

“88% of women who had a postnatal doula were still breastfeeding at 6 weeks and 67% were still breastfeeding at 6 months (This compares with 21% at six weeks and 7% at three months according to the Infant Feeding Survey of 2005 (Bolling et al 2007).”

Of course, it could be argued that doulas serve a small, well-educated, middle-class elite. This might have had a kernel of truth years ago, but these days doulas serve a broad spectrum of parents, right across the socio-economic scale.

This aspect to my work as a doula is one that gives me equal amounts of pleasure and pain: I am constantly enthralled watching my clients step into their power as nursing mothers and just as often appalled by the hurdles they encounter along the way. Today, I visited a mother who was putting her baby to the breast only twice a day and bottle feeding formula the rest of the time. She desperately wanted to be a breastfeeding mother – and nothing discernible stood in her way; she wasn’t in pain, and had a good supply of milk, given how little she was breastfeeding. When she talked about how she was feeling and what she wanted, she explained why she wasn’t nursing by telling me that she just felt like she ‘didn’t know how’. Her normal, as a nanny for many years, was the routine predictability of formula-feeding.

I asked a few doulas what it is they think makes such a difference to parents’ experience of feeding when they have the companionship of a doula.

“Because we have time, and we approach it with love and kindness and because we know how much it matters to our mummies and their babies.”  Lindsay Gale

“It is because we give, as in everything doula-y, a magic mix of unbiased, non-judgmental informational, physical and emotional support. And…time is everything too.” Sophie Messager 

 “I do breastfeeding support at the hospital and it’s so different to supporting at home. In our ward there are 4 ladies to a room, its hot and stuffy and noisy, there’s only one chair per lady and most of these are too high. Compare this to my last doula client who got back into her own bed and fed lying down!” Staci Doula Sylvan

“Because we are invested. We genuinely care for these women and are willing and able to go the extra mile to support them in achieving their goals. As long as they want it we will be there, cheering them on, making sure that what they are doing is still what they want. We show them what good signposting and consistent support looks like and hopefully that ripples out into the world.” Jo Gough

“Sometimes it is just the sitting with a woman whilst she feeds, talking about anything or nothing, giving her the confidence to just be and learn her baby.” Mars Lord

“Because we believe that women, their bodies, their breasts, work – and we offer the support, nurturing and love needed to make it so by allowing oxytocin to flow freely. Doulas bring oxytocin (both a hormone and a pheromone) to every situation and there are few, if any, situations that it will not help. A good doula oozes it from every pore, she models, and literally smells of, love.” Vicki Williams

Don’t misunderstand us, there are Midwives, Health Visitors, Breastfeeding Counsellors and International Board Certified Lactation Consultants out there who are doing just this, and more. Working long hours, often in a volunteer capacity, supporting mothers as they start their feeding journeys. Doulas are just women, believing in women. Some of us are trained, qualified breastfeeding supporters too. But the particular role of the doula is to be that constant companion, the one who drives you to the support group, the one who rings the Lactation Consultant for you. The one who knows when things are normal and crucially, when they are not. The one who doesn’t have a badge or a uniform. The one who has the time to just ‘be’.

As Lindsey Middlemiss, breastfeeding supporter-turned-doula, says: “Part of the reason I wanted to become a doula was because as a breastfeeding supporter I often got involved with a family 2-3 weeks in when small issues had become big issues. As birth doulas, we support feeding continuously from pregnancy, through birth, the first feeds and the first days.”

A doula’s prime role is to be your still centre. A maelstrom of emotions whirl around in the early days – and we are alongside you listening. We suck up some of that emotion and shoulder some of the burden. Sadly, these days, many mothers may not have anyone, other than her doula, who knows anything at all about feeding babies and who doesn’t have strong opinions they feel compelled to share. More than that, your doula will probably have intimate knowledge of how YOU feel about feeding YOUR baby.

“My doula didn’t pressurise me into making a feeding choice the whole of my pregnancy when I was unsure which way to go. When my son was born and I put him to my breast it was instantly decided (by me) that I was going to bottle feed and without any judgement my doula went into the kitchen and pressed start on the steriliser! I could not have been more grateful to have a doula who supported my choice without question 100%. She knew me well enough to know that I was making the right decision for me and my baby and she respected that.” Lauren Derrett

In other words, a doula will be there for you, unconditionally, completely, whatever and whoever you are and whatever you do. And she will move heaven and earth to carry out your wishes.

“Waking up from an emergency c-section to see my baby snuggled under my husband’s shirt was amazing. My doula enabled Ian to clearly explain my wishes and had the time to help him to achieve our priorities for baby.” Sue Searle

In the midst of conflicting advice, well-meaning help that is sometimes more of a hindrance, undermining comments and judgements from those around her, the doula may well be the one person who says things like:

‘How does that feel?’
You’re doing so well’
‘How do you feel your baby is doing?’
‘What would you like to do?’
‘What do you think you need?’

Like other mammals, we learn by example. We are a circle of mothers, evolved as a tribal species. Without our womenfolk around us, passing on the wisdom and practical skills, is it any wonder that breastfeeding has become mysterious and difficult and oh, so lonely?

“After listening to a client for ages the thing she kept repeating was “and the poor dog isn’t getting walked” so I did that and by the time I got back babe was happily feeding – funny that!” Debra Virchis

With cup of tea in hand, we see you bring her to the breast. We smile encouragingly. Remind you to keep her close, so close no-one can see where your body ends and hers begins. You are One. She feels safe. She is part of you as she feels her belly and chest sink into you. She feels her chin planted squarely on your warm, sweet-smelling breast. She reaches up, tipping her heavy head back, gaping open with her hot mouth and you draw her ever closer. Her search is over. Her whole body melts as the warm, sweet milk begins to flow.

Whether you choose to breastfeed, formula feed or a bit of both, whether you reach your goals, or intend to go with the flow, you are not feeding your baby in isolation. You are the product of millions of years of history and culture and subject to the whims and pressures of this particular point in history.

I once did a little internet search. I googled “Is Breastfeeding…” the top results are:

…best?…hard?…in public legal?

I then turned the words around: “Breastfeeding is…” which produced …painful, …hard, …so hard, …best, …gross, and …disgusting

This pretty much sums up the attitudes and feelings around breastfeeding that I encounter on a daily basis.

We use breasts to sell cars and newspapers, we enlarge them, lift them, encase them in lace and show them off (as long as no areola or nipple peeps out of course!). They are simultaneously our badge of womanhood and our cross to bear. We are judged and judge ourselves on the state of our jugs and simultaneously worry that they may let us down, sag, lose their allure or even kill us. Somewhere, along the line, we’ve forgotten what these mammary glands are for. It seems our culture has swallowed the misguided notion that breasts are genitalia. And if that is the case, how on earth do we get them out of our bras and attach babies to them?!

If, like me, you have worried all your life about how your body is seen by others, defining your self-worth by your size and shape, breastfeeding can seem particularly complex.

Are these second rate tits up to the job? Are they fit for public consumption?

We are taught that our bodies are fragile and liable to break down. We constantly compare ourselves to the most beautiful and find ourselves wanting.

Those of us who work in this world of breasts and bodies have to inhabit a shadowy world of taboo, hang ups, revulsion and longing. People have complicated relationships with their bodies. We have to explore the hinterlands of our own attitudes; understanding that the way we fed our babies and how we feel are all irrelevant: this is all about YOU.

The social mores of our time are that mothers are expected to breastfeed. We are encouraged to at least give it a go by our midwives, antenatal teachers and doulas. Everyone bangs on about the benefits to the baby. So many of us assume breastfeeding is a natural instinct: how hard can it be? Hardly anyone talks about the potential dark side of breastfeeding; the challenges and the pain, in case mothers are put off.

The result? Mothers who are inadequately prepared for breastfeeding and who lack good support. The irony is that, if mothers don’t know about the possible challenges they may encounter as they learn to nurse, they are more likely to encounter these challenges, more likely to assume they are normal or that nothing can be done about them, and less likely to seek help.

It’s like trying to learn survival skills, in the jungle, alone, armed only with a butter knife.

Because….here’s the thing: breastfeeding is driven by an engine of instincts, hormones and reflexes in both you and your baby. However, you may need a little bit of help to learn to control that engine. Knowing when to change gear, accelerate and break, judging your speed, the needs and intentions of your fellow road users and gaining confidence as a driver is a subtle process of learning and growth. But like driving, nursing soon becomes a thoughtless action, one that can be done whilst having a conversation and thinking about what you’re going to cook for your evening meal.

But without someone to sit next to you in the passenger seat, what happens? Mothers can feel betrayed, let down and pressurised…or maybe even more sadly, think they have failed and are filled with guilt. The reality is – they have been failed by the very system that was meant to support them. And these mothers can feel bitter. Some will even spread the idea that breastfeeding is painful and difficult and lots of people just can’t do it. This isn’t perfectly true. And it doesn’t do much to help you achieve your goals, in your way, with your baby.

The truth is, so many women get so little skilled support in the early days that there are lots of women out there either learning to drive all by themselves or being guided by people who are passing on misunderstandings, myths and over-generalisations. That means there are lots of people crunching their gears, or even stalling the car altogether. Some people might imply that if you just TRY a little harder, or wait a little longer, it will all work out. Some might try to tell you it’s your fault you’re finding it difficult. Of course that won’t help if you never know not to crunch those gears or if your baby has challenges of her own. It means that sore nipples or achy breasts or other worries don’t get addressed.

Just because something is common, doesn’t make it normal.

There are lots of theories about how we’ve got to this place; not least the powerful multinationals that have a vested interest in your baby not breastfeeding. Along the way, somehow culture, economics and big business have taught us not to trust our bodies.

From conception to birth to feeding our babies, technology and capitalism pave our way and cushion us from the visceral experience of our mammalian nature. It appears that the more disconnected we get from our bodies, the more we rely on science, money and technology; even believing it to be superior to the model that nearly 2 million years of evolution has perfected. The bottle has become the symbol of motherhood – the iconography is everywhere; on baby changing rooms, congratulations cards and in the media.

Our bodies have become a necessary evil – we leak unsavoury fluids and are inconvenienced by pain and dysfunction. And from unsavoury and inconvenient, it’s only one small step to distasteful, abhorrent and eventually, taboo.

These complicated feelings and powerful cultural messages can have a real and tangible effect on your experience of motherhood.

The last couple of generations has seen a resurgence in interest in breastfeeding. But there’s a good chance your mother and even your grandmother bottle-fed their children. Women are growing up disconnected from nursing, without the faintest clue how a baby latches or the natural rhythms of a nursing newborn.

When our mothers had babies, it was really believed that formula was a modern, scientific advance on nature. In the age of female emancipation, the bottle offered a freedom that ordinary women, without access to wetnurses, had never had before. The idea that breastfeeding, and therefore being somehow ‘chained’ to the baby, is a rather anti-feminist pursuit is still rather prevalent in some quarters. But the notion that a woman must resist the temptation to give in to her biological urges to make love, procreate and lactate in order to earn her feminist stripes is, of course, nonsense.

It is only in recent years that we have begun to gain a deeper understanding of the way that breastfeeding works. What I mean is that, for the last few decades, we have had a very simplistic notion of how to teach a mother to breastfeed – that it is she who is the ‘doer’ and the baby the ‘receiver’.

We have been sold an idea of breastfeeding as a series of ritualised movements or steps that are the same for everyone. A very ‘mother-led’ activity, measured out by the clock into arbitrary slices of time. Actually, it is the baby who breastfeeds – the mother merely providing the habitat, or appropriate environment of her body, her attention and her desire to nurse.

Provided that you and your baby are allowed to bathe in an oxytocin-rich environment, the chances are that your baby will latch, and keep latching.

When you look up from your bubble to ask if things are ‘right’ or ‘normal’, your doula will give you the same kind of support that she would provide in labour – reassurance, quiet faith in your ability to know your body and your baby. ‘How does it feel?’ we should whisper. ‘Is your baby enjoying it?’ ‘You know how to do this – the knowing is deep inside both of you’.

Sadly, much of what we do during birth and immediately after serves to impede this oxytocin-rich environment post-birth. So much seems to result in the oxytocin-bubble being burst. Drugs and instruments and surgical procedures can put a brake on the baby’s natural reflexes to find the breast. Not as much is said about all the little things that can happen, even after a drug-free birth, that can burst the dyad’s oxytocin bubble:

  • The baby having a very ‘hands on delivery’ so she may feel tense and even in discomfort.
  • Early cord clamping, which can interrupt the ‘birth pause’, speed up and disrupt the baby’s transition from womb to world.
  • Separation of mother and baby  – delaying skin to skin and potentially missing that golden window when everything maximises the possibility of the baby latching without hindrance.
  • Baby cleaned and wrapped; disrupting those magical moments of smell and touch as the baby finds her own way to the breast.
  • The baby being presented to the mother; laid in her arms rather than in chest-to-chest contact. I have noticed that rather than an instinctive discovering of each other that happens naturally when motherbaby are in chest-to-chest contact – the mother shifting slightly and making her body available to her wriggling infant – when the baby is lying on her back in the mother’s arms, the mother is more likely to look up and ask for help or ask a question about what she needs to do to ‘feed the baby’.
  • All the other fuss of a standard delivery unit and excited family members – hats, weighing, vitamin K injections, the hurrying of the 3rd stage, bright lights, staff coming and going, phone calls made, photos taken.
  • The mother or baby being washed too soon. The smell imprinting necessary for safe attachment is well understood in animals, but rarely discussed in humans.
  • The mother not kept totally warm, thus lowering her oxytocin levels, possibly delaying the birth of the placenta and making it less likely the environment will be primed for the baby self-attaching.
  • The mother not feeling safe, private and unobserved because this, too affects her oxytocin levels.
  • The ‘BABY-TO-BOOB HEAD SHOVE’. This ‘technique’ which involves grabbing the mother’s breast and the baby’s head and pushing the two together in the hope they will stick has, in my experience, caused more anguish than almost any other routine postnatal procedure. Mothers complain of feeling bruised, violated and alarmed at the violence of the gesture. Babies make their feelings known as well – by refusing to latch, screaming blue murder every time they see a breast, of arching back against that strong hand on the back of her head. If someone rudely pushed on the back of your head, what do you think you would want to do? I humbly suggest not letting anyone do that to your precious baby. Like any jigsaw puzzle, it doesn’t help to force the pieces together.

The desire to have a baby is imprinted deep in our genetic coding. It is not a rational, neo-cortical decision. Likewise, the inclination to the put the baby to the breast is a biological urge. It is a feeling, deep in our wombs and hearts and guts. When our babies flail around and don’t latch, when they push against us and arch away, when they spit out the nipple, when this thing we yearn to do hurts, when our nipples bleed or when our beloved babies don’t gain weight; when all around us talk about the ease and advantages of formula; when lactation seems just too hard to master, the grief can be deep and damaging. The sense of rejection and failure can be all-consuming and the anger can be debilitating.

The end result of massive formula company marketing budgets, low quality training for health professionals, zero understanding of how breastfeeding works amongst the general population and the deep hurt of some mothers is a culture of fear and distrust of breastfeeding. When pain and regret collides with the understandable pride and joyful flush of oxytocin that bathes breastfeeding mothers, sparks can fly. How convenient for the formula companies, as they portray themselves as the supporters of mothers who are victims of the ‘mummy-wars’. Of course, in any discourse, there are the minority who are evangelical and judgemental, on all sides of every debate. In general though, if you are breastfeeding and someone tuts, they are just a product of their culture. If you are formula feeding and a mother talks about how happy she is to be breastfeeding, she isn’t trying to make you feel guilty – she’s just enjoying her choice and expressing her pride. Be happy for her.

Of course, you might be reading this wondering why so many people get their knickers in a twist about infant feeding. We are surrounded by outwardly healthy gorgeous children who were formula-fed. We are lucky, in the West, to have access to electricity, clean water and high quality health care. However, the fact remains that over populations, even in developed countries, formula feeding affects the health of mothers and babies. Formula is lacking in many of the properties that are necessary for optimal health and development. That is no-one’s fault – we just can’t reproduce a living, ever changing fluid in a factory.

Formula can be contaminated. It boringly tastes the same, every single meal. Air miles, landfill rubbish and the use of water and electricity contribute to the global ecological disaster that threatens to engulf us. The companies that sell it use unethical marking practices, break laws and violate an international code designed by the World Health Organisation to protect all mothers – those who are both breastfeeding and formula feeding.  The companies are trying very hard to get to YOU. They market other products with similar branding, persuad Health Professionals to endorse their product and spend millions on advertising. In fact, if formula advertising was controlled in the way that campaigners are advocating, formula would be a fraction of its current retail price.

Formula saves lives. When there is a clear medical need, we are lucky to have access to a milkfood that will usually ensure our babies’ safety. If, for whatever reason, breastfeeding isn’t for you, you deserve access to unbiased, evidence-based information about formula together with non-judgemental support to feed your baby in a way that suits you and your baby. You certainly deserve an affordable, high quality product that is well regulated, comprising ingredients that experts agree are optimal and safe.

Mothers have the right to purchase a product that is presented in packaging that doesn’t lead them to believe, through health claims and strap lines, that this product will be better for their babies than the competition. Babies are far too important for expensive formulas to be better for your baby than cheaper brands. No Food Regulatory Agency worth their salt would allow that. They are all the same, so choose one that seems to suit your baby and that you can afford.

Normal newborns feed at least 8 to 14 times in 24 hours. Often almost constantly in the evenings! Sometimes, when they are very little, it’s hard to know when one ‘feed’ ends and another begins. But there will be respite – they do sleep sometimes! Part of the reason nature set it up this way is to make you sit, rest, nurse, recover from childbirth, stare at your baby and be tended to. If you haven’t got someone fanning you with a palm frond and peeling you grapes, consider reaching out to friends, family or your doula!

There are many and varied discussions about things like the size of newborns’ stomachs, the rate at which milk is digested, the newborn’s need for sleep in order to grow and the baby’s need to suckle for reasons other than purely nutritional. It might help to understand that breasts are factories, not warehouses; you are never empty. And when you feel, at the end of the day, that your factory really must have gone on strike, your milk, whilst low in volume, is super fatty and comforting – an evening cocoa for a baby who has been working hard all day getting used to the world.

We also all have a unique ‘storage capacity’; in other words, the volume of milk we can store in our boobs at any one time. A woman with a large storage capacity may fill her baby up to the brim and find her baby tends to feed less often. Those of us with smaller capacities may have a baby who needs to suckle more frequently. The amount of milk each mother makes, however, in a whole day may be pretty much the same.

Like any factory, if the customer is asking for more, the workforce has to ramp up production. If you feed less, perhaps because you are using some bottles, the factory will compensate by slowing down production. In this way, our body and baby work together to make sure we make enough milk for our babies and don’t go pop by making too much. The system works well for most dyads, but not so well for a few so if you feel you have too much or too little milk, get some skilled support.

So because you can pretty much expect your newborn to want to hang out on, or near your breast pretty much constantly, mother nature has set up a system of rewards: the hormones of breastfeeding are feel-good relaxants, reducing stress and sometimes sending you off into a rather blissed out state (not always of course: doorbells ring, other children demand our attention, the toast burns…). Mother Nature WANTS you to breastfeed, not for days, or weeks, or months, but years. So she makes it a rewarding experience. If your nipples hurt, or anything else is upsetting you about your breastfeeding, this is not what the system intended – and there are an army of skilled, passionate women out there, aching to help you…and keep on helping you until everything is fine, or you tell them to clear off.

Basically, babies are hardwired to have physical contact with another human body and to suckle frequently. Babies suckle for food, drink, pain-relief, reassurance, to go to sleep, to wake up, for entertainment and for most other emotions any other human being might experience. We have spent the last couple of hundred years trying to deny that humans are a carrying species, earnestly trying to get mothers to feed and comfort their babies by the clock and transport them with wheels. Fortunately, babies (or your breasts!) can’t tell the time – nor can they usually be fooled by vibrating chairs or expensive prams. They may tolerate them, but what your baby really needs in the early days is you. You may like to explore the idea of a sling/cloth carrier – babies have evolved to expect to be carried, but grown-ups need their hands free. A sling keeps both parties happy.

Babies are just small humans – most adults enjoy oral and skin to skin stimulation – we eat, drink, kiss, cuddle (and more!) and some of us smoke. The needs we have as babies continue throughout life!

There really are only three rules to breastfeeding: 1. Feed the baby (by hook or by crook, in whatever manner and with whatever milk – yours, another woman’s or modified from a cow – your baby will need feeding). 2. Protect your milk supply (if you take out your milk, by putting your baby to the breast, or expressing with your hand, or pumping with a machine, you will send a strong signal to your brain to MAKE MILK. If you make milk, you can fulfil Rule One. 3. Keep your baby close (if you have close contact, including skin to skin, you will stimulate your supply and fulfil Rule Two, and encourage your baby to latch frequently, which fulfils Rule One and Rule Two).

If your nipples are comfy, your baby is weeing and pooing and has some settled times and she’s getting bigger, you can probably rest assured that things are going swimmingly. If these things aren’t happening, or you have any anxieties, pick up the phone or go to a support group. There will be someone, somewhere who has the key to unlock the door to pleasurable breastfeeding. Most of them, trained by the charitable breastfeeding organisations, should support you free of charge.

Your doula will be your signpost, pointing you towards skilled, loving, knowledgeable, non-judgemental breastfeeding supporters if you need them. The groups they run are a safe haven, even if you don’t have any challenges to overcome. The friendships many mothers make in these groups can last a lifetime.

I’m giving the last word to my friend, mentor and inspiration, Rachel O’Leary. La Leche League Leader, International Board Certified Lactation Consultant, mother, former Baby Milk Action Trustee, lifelong breastfeeding advocate and enthralling storyteller. This is why she carries on supporting mothers to nurse their babies if they want to. It sums up what gets so many doulas and breastfeeding supporters out of bed each morning.

“My main motivation is rage. I’m furious that mothers are denied the right to enjoy breastfeeding their babies – because there is (apparently) no capacity in our greedy world to offer simple support and accurate information. I am outraged that the formula and bottle companies have destroyed our confidence in a woman’s capacity to feed her child. I seethe when I see the links between women trampled by big business, with their ‘care’ lines that peddle misinformation. I am also motivated by the relief that women express when they find answers to their questions, and the generosity with which they share with their friends. I am in awe of women’s determination to breastfeed their little ones, in the face of pain, physical trauma, criticism and confusion. Helping mothers learn to breastfeed their babies is the most satisfying work in the world; I’ve never found anything that’s so much worth doing.”

Maddie Headshot 2020