Why is nursing so difficult?

When I first became an IBCLC, my mother would not infrequently lament to me that she had no idea why such a profession even existed. "I nursed all three of my babies without any help at all," she boasted.

Well, that's nice for you, mom (and nice for me, too, since I was one of those babies!). Sometimes, nursing does come easily to new parents, even when they've had little exposure to nursing babies before. And I often hear flavors of my mother's sentiment echoed in others who—while they understand intimately that nursing IS in fact quite challenging—don't understand why nursing is so hard if it's truly what our bodies are "designed to do." In cultures around the world, the vast majority of mothers nurse their babies successfully (they often don't have a good alternative), and surely they're not all relying on lactation consultants to help them through the hurdles of the early weeks. Why is it that women in our culture struggle so much with something that should be so natural?

It's time to tell the gorilla story. The gorilla story is rather infamous among those in the U.S. lactation world, though oddly, it is very difficult to source (believe me, I tried!). In the 1980s in Ohio, a female gorilla in captivity gave birth to her first baby. Never having been around other mother gorillas and babies before, this new mother gorilla didn't have a clue as to how to care for her new infant. She did not know how to feed it, and the baby gorilla died. 

When the same mother gorilla became pregnant for a second time, the zoo tried to better prepare her for success; they called La Leche League. LLL is an international organization comprised largely of volunteers—actively nursing mothers, and mothers who have previously nursed their babies—who offer mother-to-mother support to nursing moms. In the gorilla story, nursing mothers from a local LLL group came each day to nurse their babies in front of the pregnant gorilla. At first, the gorilla wasn't terribly interested in the mothers, but as her due date approached, she seemed to be paying close attention to the nursing babies just outside of her enclosure. And when her second baby was born, she successfully nursed and cared for it, just as she had been watching the human mothers do throughout her pregnancy. 

Photo credit:  Clara S. 

Photo credit: Clara S. 

It turns out that nursing is not an automatic or "instinctual" behavior for human parents, nor for any of the other higher order primates. Nursing is a social behavior, and the skills needed to nurse a baby are learned skills, not unlike the skills needed to eat with a fork and knife. Babies are born with some instincts that help a new parent out (they can root for the nipple, "crawl" towards the breast, and attach themselves without any instruction or assistance), but new parents need to rely heavily on other humans to teach them how to nurse their babies. 

In cultures where exclusive breastfeeding is the norm, a new mother gives birth to her first baby already having witnessed countless other mothers nursing their babies, usually in an up-close and intimate way. In the U.S., many mothers give birth to their first baby never having even held a baby before, and without ever having seen a single full nursing session from start to finish. The breastfeeding rates in the U.S. have increased somewhat dramatically since the 1980s (when I was born), but have mostly plateaued since the turn of the century. Here is the data from 2014:

From  the CDC

From the CDC

Only 40% of babies born in the U.S. are still exclusively breastfed at 3 months of age. This means that 60% are either entirely or partially being fed with artificial baby milk (ABM), presumably via bottles. So the majority of babies that anyone living in the U.S. will see about town will likely be taking bottles (a situation that is exacerbated by low tolerance/ comfort re: nursing in public). Many, many new mothers in the U.S. aren't much better off than the gorilla in Ohio when they give birth to their first baby. They mostly have had no exposure to nursing mothers. Thank goodness human mothers have much more readily available human support than the gorilla did! Still, it's really no wonder that so many mothers struggle to make breastfeeding work in the early weeks. 

Other factors that can compound the difficulty of nursing while living outside of a breastfeeding culture are the medicalization of childbirth, and some mainstream parenting practices left over from the era wherein nearly all babies were bottle-fed. But I will save my thoughts on those factors for another day.