The challenge of making baby formula part 1.

When physicians in the US decided at the end of the nineteenth century to put their minds to making safer infant formula, they really threw themselves into the task.

Rima Apple’s history of infant feeding in the US: Mothers and Medicine, describes the complexity of the task of modifying cow’s milk to make it ok for little babies.

Possibly for many many years, cow’s milk was diluted with water as a simple substitute for breast milk.

From what I can gather, it seems like most babies would have had as much breastmilk as could be obtained from mother or other(?), with top-ups of cow’s milk or combinations thereof.  The almost official medical view was that most women were incapable of producing an adequate breastmilk supply, and that most breastmilk was of dubious quality (diet, exercise and sweetness of temperament were essential ingredients for ideal milk production).

The solution was to offer a cow’s milk substitute. Sound familiar?

I can only guess that the ill effects of tiny babies drinking raw watered-down cow’s milk were usually counteracted by the benefits of whatever breastmilk they were also receiving. Or not.  In some US cities in the 1890’s more than one third of babies died before their fifth birthdays. Somewhat complicating this was the widespread public view that bottle feeding was indeed dangerous for babies.

Understandably, there were concerns about the bacterial load in cow’s milk that arrived in urban centres from rural areas: raw, unrefrigerated and in open vats. Customers were often seen to take a sip of milk from the dipper to check for freshness and even home delivery of cow’s milk saw the milkman using the same dipper to fill household vessels (clean or cleanish) for every household on his delivery route. The milkman delivers!

So began campaigns to make cow’s milk safer for everyone: promotion of home pasteurisation, legislation that meant lids for milk vats were compulsory, milk stations positioned in urban centres with quality control standards and educational pamphlets for mothers…. and eventually, refrigeration for transport vehicles carrying cow’s milk.

But the real science was in the way cow’s milk was changed to suit a baby human’s digestive system. Complex percentage systems of adjusting the cream and water and milk sugar were devised by physician Thomas Morgan Rotch. He also added lime water (calcium hydroxide) to make the rather acidic cow’s milk more suitable for baby’s digestion.

For family doctors and paediatricians he recommended a chart be used that had 30 different combinations of cow’s milk formulae for babies up to 12 months old. Mothers were expected to consult regularly with their doctor for feeding adjustments in their baby’s first year.

Ironically perhaps, this multitude of different concoctions was designed to reflect the way mothers’ breastmilk varied over time.

And breastmilk continued to be recognised as the best way to feed a baby.But if there was difficulty with breastfeeding, there was little medical understanding of how problems could be remedied, part from offering bottles.

Rotch was influential in his work, but ultimately public health officials demanded simpler systems of devising baby formulae.  Importantly, the medical profession insisted that they be the first point of contact for guiding the mother in feeding her baby.  Manufacturers of baby milks or modifiers usually encouraged this too, or at least with some of their milk products.

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Cult of the mother.

I’ve just spent a good many hours reading a book about the history of infant feeding in the USA.

Mothers and Medicine: a social history of infant feeding 1890-1950. By Rima D.Apple

It has been interesting to learn about the way breastfeeding was viewed at the end of the nineteenth century, just as artificial baby formula was being developed.  Although this is definitely a history of the US experience, we can allow reflections on breastfeeding in Australia where many broad cultural themes were similar, such as the role of science and medicine in everyday life, and the lived experience of women.

The “cult of true motherhood” or the “cult of domesticity” described how women were viewed in the latter part of the nineteenth century: women were defined by their role as mothers, and were entirely responsible for the well-being of their children.  Kind of nice to have the recognition, but at times it would have been a tough load to carry.

In the nineteenth century in the United States, breastfeeding was generally seen as the best way to feed a baby, but the lactating breast was also seen as a sensitive and unpredictable organ: milk supply could be effected by anything from a “fretful temper” to a “fright”, and breastfeeding was likely to overtax the mother’s well-being, causing a “general weariness and fatigue”. Lactating women were encouraged to eat well, exercise a little and cultivate a serene disposition(!).

Go on…breastfeed…just make sure you do it perfectly. Oh, and good luck.

The second best way to feed your baby (should your unpredictable breasts not do your asking, despite your serenity) was for another woman to feed your baby. But wet-nursing was also problematic: how to ensure that this woman from the working class would be eating well, maintaining some serenity and not wasting her precious milk on her own infant? Never mind the enduring view of character being conferred by a baby’s food source.

Infant mortality rates were alarming, criticism of wet nurses widespread. The medical and scientific solution to the problem was to further develop baby formula. Bottle feeding was seen as a thing able to be manipulated by science, unlike the vagaries and uncertainties of that most female of activities: lactation.

And so began an era of medical advice for infant feeding. While mothers were very special people who were expected to take responsibility for their children’s upbringing, they would need a little bit of help from medicine if breastfeeding wasn’t working. That help would be in a bottle of baby formula, perhaps suggested by a doctor qualified in the newest of medical specialties: paediatrics.o-VICTORIAN-BREASTFEEDING-PHOTOS-570

Why do a PhD?

You get that look … you know the one … their face contorts into a pretzel shape (without the salt) … then they say: “oh, you poor thing.”

I’m telling people at a random social gathering that I’m starting a PhD.

The people who know me a little better, who have had the long chats and emails with me about the reasons why more women don’t breastfeed for longer, or have read my multiple Facebook shares of the amazing properties of breastmilk, or have witnessed my frustrations with poor support for breastfeeding mothers, or come along to ABA meetings with me … they smile and say: “of course you’re doing a PhD, and yeah, I know it’s about breastfeeding – what else could it be?”.

I’m doing this study because I want to change the world.

Well, I’m doing it because I want to learn how to do research, and what’s the point of doing research if you can’t create change?

So don’t feel sorry for me, because I am in a very fortunate position.

For the last 18 years I’ve been very interested in breastfeeding. When I was a student midwife, I spent lots of time with women on the postnatal ward, watching midwives help them attach their babies, watching them attach their babies, watching their babies feed, agonising when they decided to stop breastfeeding before they left hospital (despite all my slightly creepy watching!) …wondering when I would be able to actually help any of these women with all… this.

When my eldest child was born, I started learning a bit more. She was a post-term induction, born with her own polo neck sweater (cord around 3 times, tightly) … and I am proud to say that I had grazed nipples when I left the hospital 24 hours later. Ouch. What a midwife.

A kindly lactation consultant helped me attach her firmly and painlessly about 5 days later.  Her words: “this will make you a better midwife Jen”. Damn tootin.

And so a monster was born (that’s me).

For the last six months I’ve been reading about breastfeeding, thinking about breastfeeding, writing notes and mind maps and emails about breastfeeding. All with permission.

So don’t feel sorry for me.

I just hope all this will be enough to change the world … maybe just a little bit.

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