Coda to public breastfeeding article

The CNN article referenced in my last post is published- verbatim- under a different title in AOL.com "Many Outraged by Breast-Feeding Magazine Cover". Sounds like a different article altogether, doesn't it? How's that for spin?

The acceptance of breastfeeding in public: CNN.com's "Lactivists: Where is it OK to breastfeed?"

On Thursday (July 27, 2006) CNN.com published an article titled “Lactivists: Where is it OK to breastfeed?” that covered public reactions to the recent Babytalk magazine cover featuring a close-up of a breastfeeding baby. The photograph consists primarily of the latched-on child’s face while the mother’s breast is partially visible (side-view, no nipple).

Though the title asks the question ‘Where is it OK to breastfeed?’ it really focuses on the perceived social acceptance of public breastfeeding within mainstream America. From the article one would get the impression that, celebrity breastfeeding bra-watching aside, there is a general lack of support for women to breastfeed in public. Yet a closer look seems to suggest that this may be the result of how the issue is being presented.

For example, the article emphasizes the fact that this particular issue of Babytalk received over 700 letters in response, and goes on to quote some of the negative comments they included. It does not say, however, how many of those 700+ responses were negative, and how many may have actually expressed delight or support for the image. In the same vein, CNN reports that the majority of the free magazine’s audience is mothers, and that “in a poll of more than 4,000 readers, a quarter of responses to the cover were negative”. Notice how a simple switch of that statement creates a different impression: “in a poll of more than 4,000 readers, 75% of the responses to the cover were positive or neutral”. Sounds like a different audience, doesn’t it?

The article contains the usual comments of ‘breasts are sexual’, and of women wanting their husbands and sons to be shielded from these inappropriate sightings of breasts. Even though one woman is quoted as supporting the cover because “it helps educate people that breasts are more than sex objects”, her support is quickly neutralized by her admission that she does not breastfeed in public and her statement that “Men are very visual...when they see a woman's breast, they see a breast -- regardless of what it's being used for."

This last statement is problematic on many levels. One, it assumes that men’s reactions to breasts are somehow biological and not cultural, an idea that can be quickly discarded by noting that there are many cultures where breasts are not strictly defined as sexual (a fact that can be ascertained by a quick stroll through any European beach). It is also demeaning to men, as it reduces them to visual creatures that are unable to control their sexual reactions to women. And not least, it assumes that breasts are just sex objects, and that by education we mean only that people should refrain from publicly reacting to them. Why insist on such limited perspectives and expectations?

In fact, there’s no discussion of the problematic way in which our culture unnecessarily sexualizes young girls and teaches them to feel shame before they have even reached sexual maturity. Do infants and small children really need two-piece bathing suits? Why cover the chest of a baby or little girl who has nothing yet to cover? By doing so, we highlight a future sexuality that has not even manifested itself, and we teach both girls and boys that our bodies are, primarily, sexual and consequently subject to public shame.

One final aspect of this article, and of the breastfeeding debate in general, is that it doesn’t consider what types of positive messages public breastfeeding may send to girls. In a country where distorted media images of female beauty have succeeded in creating countless health and self-esteem issues for women and particularly girls, it seems that an acceptance of public breastfeeding would provide a good antidote –to both boys and girls- to the notion that women’s bodies are mainly sexualized objects to be gazed at by others. A woman breastfeeding her child is a reminder of the multiple capacities of a woman’s body, and of the fact that all bodies are vehicles for many experiences, of which sex is just one. As the last quote in the article states, breastfeeding is a moment between a mother and her child, and precisely because of that it should be an intrinsic, normal part of our social fabric, and not one to be relegated to bathrooms or kept behind closed doors.

A Loaded Opinion: Dr. Darshak Sanghavi and "The Mother Lode of Pain"

The Boston Globe’s Sunday Magazine (July 23, 2006) features an article titled “The Mother Lode of Pain” by Dr. Darshak Sanghavi that presents itself as an inquiry into medicated vs. unmedicated birth. While the article provides some reasons for foregoing drugs during childbirth and even cites an interview with Ina May Gaskin (who is likely the foremost authority on midwifery today), Dr. Sanghavi’s article quickly deteriorates. Ultimately, he champions the use of pain medication during labor as the only option for ‘thinking beings’. In the process, he manages to be condescending and insulting, curiously exemplifying one of the many reasons why women have stopped listening to this type of self-serving medical opinion.

From the outset, Dr. Sanghavi stresses the importance of education, beginning with the story of Fanny Appleton who in 1847 was the first woman in the U.S. to use ether as an aid in birthing her third child. From that point on, however, the issue of education gets twisted, as Dr. Sanghavi tries to explain why even educated women choose natural childbirth. Some are dismissed as being misinformed by outdated research on early epidurals and their side-effects (p. 6 and 7), and others as being misled by erroneous information provided by childbirth classes (p. 7). Then there are those that are compared to religious fanatics and suicide bombers (p. 5), and finally those for whom labor is an 'extreme sport' (p. 7). According to Dr. Sanghavi, truly educated women are those that agree with using medication during labor, for to choose any other option is to ‘rationalize the existence of labor pain’ (p. 7).

There are several clues within the article as to reasons why women choose to birth without medication that Dr. Sanghavi does not delve into. (Unsurprisingly, he discusses only the idea of ecstatic births and reduces Gaskin’s justification for labor pain to this, thus subtly denigrating her.) The fact that women feel empowered and in control (p. 7), the idea that labor pain is a ‘pain with a purpose’ and that it does not imply suffering but may be a ‘joyful pain’ that is part of a process (p. 3-4) are, by themselves, very powerful reasons. Not to mention the fact that not all research supports Dr. Sanghavi’s premise that modern labor medication has no effect on babies, labor or subsequent complications such as cesareans. (As a starting point, Henci Goer’s “The Thinking Woman’s Guide to Birth” provides ample medical research to the contrary.) But that is material for a different post.

In the interest of fairness, and lest it seem that I am exaggerating Dr. Sanghavi’s level of condescension, I have decided to quote the last section of his article:

As a pediatrician, I have been present at hundreds of births and spoken with dozens of women who passed up anesthesia during labor. One justification I've often heard is that labor pain "empowers" women or gives them a sense of "control." But many women accept pain for a more mundane reason: They are poorly educated about obstetrical anesthesia and don't have access to compassionate and technologically advanced medical care. In that sense, Fanny Longfellow's story is especially relevant; she overcame both ignorance about anesthesia (by teaching herself about ether) and the lack of access (by finding a willing dentist when no obstetrician would tend her). She didn't rationalize the existence of labor pain.

STILL, THERE WILL ALWAYS be people who want their pain. When I was a teenager in New Jersey, I endured an optional religious challenge called the atthai, an Indian Jain custom of fasting for eight straight days. The idea is that the people should dissociate from the material world, even from something as elemental as food. Accomplishing the painful challenge is something of an ego rush; the hunger artists are honored as members of a holy community. (I look back on this now with agnostic disbelief.)

Like prolonged fasting, enduring labor without anesthesia attracts notice. It casts the mother as a struggling heroine who - by sheer mental force - gracefully keeps her body under control. "Natural childbirth purists," author Margaret Talbot wrote in the New York Times after having children with and without anesthesia, "see labor as a kind of performance for which a woman can and should rehearse, and in which she can comport herself more or less admirably. [They] regard labor as an extreme sport."

In this setting, the pain of unmedicated labor offers up a formidable, if artificial, trial that precedes entry into a highly selective sorority. It creates drama. It captures attention.

Yet pain in the end is an utterly primitive thing, a vestige of insect and reptilian brains. It evolved primarily as a way to change behavior without need for thought - to force one's hand to pull away from fire or tend urgently to an injured limb. Thinking beings, in some sense, have evolved beyond pain. (Some pain reflexes continue even in brain-dead individuals.) If anything, reliance on pain to create meaning during childbirth indicates a constricted imagination. Surely there must be more innovative challenges than voluntarily refusing effective, safe, and available pain relief during labor. As the American College of Obstetrics and Gynecology states, "There is no other circumstance where it is considered acceptable for a person to experience untreated severe pain, amenable to safe intervention, while under a physician's care."

Which is why choosing to feel pain during childbirth strikes me as odd. Eliminating pain won't create a sudden existential crisis among mothers, because parenting is too rich an experience. And after all, being born is ultimately the least distinguishing feature of being human; everyone's done it and, moreover, no one remembers it.


What, exactly, is compassionate about Dr. Sanghavi’s characterization of natural childbirth and the women who choose to birth without medication? There is no room for any opinion but his own informed, expert judgment, and women who think differently are negatively characterized as ignorant or not in their right mind. As someone who is so keen on education: How is it that he makes no distinction between Lamaze classes and the Bradley method? (I guess those ‘natural childbirth’ classes are all the same, and anyway, they are just “setting women up for failure”.)

In a few paragraphs, he manages to compare unmedicated childbirth to religious rituals or experiences (remember the suicide bombers?), then casts mothers who labor without anesthesia as struggling heroines who are seeking entrance into a highly selective sorority, thus creating drama and capturing attention. Not content to leave it at that, he goes on to suggest that women who choose not to be medicated are responding to their primitive, reptilian brain, and are suffering from a constricted imagination by relying on pain to give meaning to childbirth. We are not just childish and dramatic, but have turned into the snake itself.

Come to think of it, Dr. Sanghavi’s characterizations of women who labor without pain are more suitable to describe many in his own profession. They express an almost fanatical belief in medicine and rationalize their own shortcomings, often behave like an exclusive fraternity whose wisdom is not to be questioned, and they certainly love drama and attention. Their version of an extreme sport is to practice ever more ‘necessary’ cutting-edge interventions, and to create a need for things that are unnecessary and may even be harmful (think of some routine aspects of medicalized birth, such as episiotomies, fetal monitors, and being made to labor on your back, just to mention a few). Isn’t this really about a primitive type of envy at not having the chance to ‘deliver’ birthing women from their own bodies?

In the end, however, what is most disturbing about this article is the one-size-fits-all attitude towards women by advocating the use of medication by all, and its lack of respect for those who decide to trust their bodies -and themselves- during the process of childbirth. It may be true that no one remembers being born (and there are those who would disagree), but every woman remembers her labor and the birth of her child. Birth is not only about the outcome, as the medical profession may like to believe, but it is also about a physical, emotional and -dare I say- spiritual process in which you bring another being to life. To dismiss birth as being “the least distinguishing feature of being human” strikes me as truly unimaginative.

A Truce in the Mommy Wars

The Mommy Wars rage on, and it seems that all parenting subjects have become grounds for entrenchment, judgment, and even coercion. Feeding, diapering and sleeping with your baby have become lifestyle assertions that transcend the personal and give way to the militant. While the media, government and special interest groups are key players in this cultural roadblock to much-needed change for parents and their families, I think it would do us well to look at our own role as foot soldiers in this dirty little war.

By no means do I mean to add more guilt or responsibility to parents: my goal, in fact, is the exact opposite. Yet if we really want to change the current divisive climate and reframe the debate, we need to understand our own participation in it. In the process of thinking about this, I have found myself returning to three ideas: the role of judgment, the need for respect, and a holistic view of parenting.

It is inevitable that we will judge not just ourselves but others as parents. We do so in all other areas of life, from bigger issues such as politics and religion to mundane details like the flowers your neighbor grows in his garden. We like or dislike the choices of others, compare them against our own, and make judgments as to the types of persons we think they are. These judgments inform small decisions (whether we talk to our bus companion or busy ourselves with a book) and larger ones (whether we befriend the neighbor with the wild garden).

Our cultural climate, however, has suffered the erosion of tolerance and compromise, and this is particularly apparent in the polarization defined by the red/blue states. This all or nothing thinking has permeated parenting, where the stakes may be even higher because they conflate with the religious and political agendas of all sides. Rather than simply disagreeing with someone else’s parenting style, and often triggered by a single issue or decision, we are quick to say ‘bad parent’. And not just in our mind, but loudly and publicly.

Take as an example that much-maligned mother Britney Spears. (I use her as a common shorthand.) I am amazed at the aggressive and insulting criticism of her parenting. Now, there are many things to be said about Spears. To play the judging game, the first that spring to mind are that she is immature, impulsive and sometimes lacks good judgment. These qualities have ensured her tabloid existence, and not surprisingly have marked her parenting choices. Yet does this make her a bad parent? Why can’t she just be an inexperienced, immature, impulsive parent that sometimes lacks good judgment? Why is there a need to vilify and ridicule her? Why is calling her bad making so many people feel good?

This is where we need to exercise respect. It is essential to remember that, in the end, all (or most) parents do what they think is best not only for their child but also for their family. Even parents who are impulsive or lack good judgment are doing their best, whether we like their results or not. There are no perfect parents, including ourselves, and the tolerance we practice today may be the one that saves us tomorrow.

By no means am I condoning things like child abuse or advocating tolerance for negligence: don't get me wrong. (Keep in mind, however, that what may be negligence in your book may not be so in mine, and vice-versa. A good example of this is co-sleeping.) Yet we do cross a line when, for example, we play the “pin-the-tail-on-the-bad-parent” game simply because a mother decided not to breastfeed her child. Even in areas where the choice may seem clear to me, I try to think about what other parents may be facing. The medical profession is not necessarily helpful or without controversy, and in the same way that I don't trust a drug manufacturer to have my best interests in mind, someone else may not trust a non-vaccine advocacy group to have their best interests in mind. I have to accept that difference. Others may research an issue and come to the opposite conclusion from mine, or perhaps they may choose not to research, period. I may not agree with them, but everyone has a right to parent in the best way that they see fit, and I will defend their right to do so because only by doing so can I protect my own.

Navigating the world of parenting is not easy, and when asked about most subjects I limit myself to offering information, resources, and my own experience. It's a fine line to tread, because often in telling your experiences, you are advocating for your choices. That's why I try to be mindful about those conversations (or posts). I don't always succeed, and if you ask for my opinion I'll tell it to you straight. But it's what I aspire to, just like I'm trying to be the best parent I can.

Along the same lines, I think we need to look at parenting in a more holistic way, rather than focus on areas of disagreement. My relatives and friends make parenting decisions that are different from my own, and this should not be a deal breaker. In fact, there is much I can learn from them. Good or bad parenting, if we want to speak on those terms, are a matter of many decisions, day-to-day routines, efforts, commitments, and emotions. There are also plenty of regrets, mistakes, and circumstances beyond our control. We all win, including our children, by practicing tolerance and respect and refusing to participate in the judge-a-parent fest. As Queen Ann commented on a previous post:

Can I blame someone for choosing another way? I shouldn't, and I believe mothers deserve to be treated with unjudging respect, but I have to admit that I am not perfect at it. Am I the only one who believes in respect for all but who still struggles with unkind thoughts about women who "took the easy way out"? I find I have to work on that constantly. So I will.