Cautions and concerns
Reprinted from "Women's" issue of Visions Journal, 2004, 2 (4), p. 19-20
Breastfeeding is without question ideal for infant feeding and nutrition. There may be issues around breastfeeding, however, that are beyond the control of service providers, and persistence in encouraging a new mom to breastfeed can result in an escalation of risk factors for the infant and the mother.
Observations and experiences with high-risk women in the Burns Lake Canada Prenatal Nutrition Program (CNCP) over the last six years reveal that many of the women have fetal alcohol syndrome disorder (FASD) behaviours and characteristics, childhood physical and sexual abuse issues, limited education, and abusive and controlling partners. Many also struggle with poverty, family violence and addiction.
One of the challenges for women with cognitive1 delays associated with FASD has to do with the fact that breastfeeding doesn’t have concrete results like bottle feeding does. Individuals with FASD have difficulty with abstract ideas. In this case, the mother can’t see how much milk the baby has taken, so is unable to see the need for more food.
Staff have observed some women with FASD behaviours feed for 20 minutes and assume their baby has had enough food. In spite of support workers’ explanations of the size of an infant’s stomach and the fact that nursing newborn babies take a great deal of time, the moms are reluctant to recommence feeding. The baby’s ongoing discontent leads to the development of two risk factors: (1) the infant is not getting adequate food and (2) the mother is frustrated by a crying baby she doesn’t seem able to console.
Another factor that accompanies FASD is a developmental age far below the woman’s chronological age. Although most adults in the program haven’t had a formal assessment, workers and facilitators have observed behaviours that are generally more acceptable for eight-yearold girls: playing with dolls or sulking for an ice cream treat, for instance. One mom described the act of breastfeeding as “gross!” So, just as an eight-yearold would not be expected to have the maturity that breastfeeding requires, it may be unrealistic to expect this of some of the women in the program.
In many cases, infants suffer from symptoms associated with prenatal alcohol exposure, which leads to extreme difficulties during feeding. An infant with FASD can take much longer to feed than a typical infant because of an inability to suck properly, hypersensitivity to touch, rigidity, and physical discomfort or tension. Additionally, if the breastfeeding mother is consuming alcohol, the quality of the milk is compromised, as the alcohol level in breast milk is the same as the mother’s blood alcohol.
Other factors that may interfere with successful breastfeeding are:
discomfort associated with the intimacy of breastfeeding if there are unresolved childhood sexual issues
controlling partners who adamantly refuse to allow women to nurse
grandparents, aunts and other relatives who persistently encourage bottle feeding
professionals and paraprofessionals who don’t understand the issues high-risk women encounter, so do not provide effective intervention that includes consistency.
Reasons for opposition from partners vary and may include the following:
a degree of immaturity (if the father has FASD)
feeling threatened if service providers spend a great deal of time with the mom and focus on her empowerment.
feeling jealous toward the baby, which manifests in an attempt to limit intimacy between the mom and baby.
Many women have limited informal support systems at best, and often have no outside support. And the tenacity and determination that is often necessary to breastfeed successfully is simply not there.
If service providers and professionals lack understanding of the cognitive delays women may have, they can contribute to confusion around breastfeeding, especially if the messages they give are not clear, consistent and presented in a strength-based manner. Mixed messages, lack of support and understanding, combined with the extreme challenges that accompany FASD, can present insurmountable obstacles to a successful breastfeeding experience.
A last caution
It’s wonderful to be able to share a successful breastfeeding story. However, it’s best to be cautious about our enthusiasm for breastfeeding with mothers who are at risk. Not only can support workers and service providers put a woman’s safety at risk should her partner hold strong opposition to breastfeeding, but the infant’s nutritional intake and safety can be compromised if the mother is unable to understand breastfeeding
About the Author
Anne is Program Director for the Health Canada funded Canada Prenatal Nutrition Program in Burns Lake
Please note: This article is based on observation and by no means suggests that all women with FASD are unable to breastfeed
in other words: mental process of thought, including perception, reasoning, intuition and memory
Healthier Babies – Brighter Futures (HBBF) is a community FAS prevention program that works in partnership with other health and social service agencies to provide support to women at risk of alcohol and drug use during pregnancy. It is funded by the Ministry of Children and Family Development