What is able?

When people say that most, or 98% or 95% or whatever are able to breastfeed (often leaving off the codicil, with proper support, education and assistance) what do those who are saying it mean by able? Able to produce enough milk to fully nourish an at term infant until the introduction of solids? Able to produce milk at all? Able to have a well baby able to suckle from the breast? For that matter, what do they mean by breastfeed? Is that have the infant recieve any amount of milk from the mother’s breast? Able to latch on? It’s purely an empty catch phrase that has no scientific backing. Seriously, I knew it was kind of made up, but realized that there is no citations of the actual figure anywhere. Probably because when people say something in a research paper they have to cite where it came from and that number didn’t really come from anywhere.

If anything the assumption was made based on the breastfeeding initiation rates worldwide.  And from there expanded into a catch all statistic that simultaneously empowers women to trust their bodies and shames them when they end up in the minority for whatever reason.

I was not able to fully nourish my child from the breast, yet I breastfed her. What does that make me? Able or not? What if it was the child’s issue? Am I able but she is not? Any way this pans out, labelling just the mothers as able or not reduces the complexity of the mother and baby breastfeeding dynamic to insultingly simplistic levels.

Let us break some of those potential ables down.

Able to make enough milk to fully sustain a healthy at term infant until the introduction of solids.

Low supply falls into two main camps. Ok, more than that, but bear with me. There are those who make less than 50% of what their baby requires and those who make more than 50% of what their infant requires.  It seems to be that those who are below 50% are more often than not below 1/3 as well. Those who are above 50% are generally more receptive to methods of boosting supply and have a better chance of achieving a full supply either with the current baby or with future babies. Are either of these groups able to breastfeed? I’d say they don’t meet the fully nourish an infant on breastmilk alone maxim, but would meet the produce milk, and have baby suckle requirements. Is that enough to say that that woman can breastfeed? Implying that if due to needing supplementation her child develops flow preference or nipple confusion and will no longer latch or suckle, that she could have breastfed if…what? If she didn’t feed her baby enough? Implying that finding the hassle of having to feed the baby twice to be too much when there are other options available is somehow lazy? Bullshit. For all intents and purposes that woman can not breastfeed. If she chooses to do, and is able to continue so despite the obstacles, then I’d say that’s amazingly lucky and not at all the norm.

Able to latch on correctly and suckle from the mother’s breast.

So tongue tied infants may not be able to latch on, or latch on correctly. This can cause gross tissue damage to the mother, pain, persistent infections, lack of milk transfer and a range of other issues. This is something that with treatment can often be remedied if fixed early. But without treatment or delayed treatment can cause a host of issues that generally ends in the cessation of breastfeeding. We know the rates of this are at least 4% and potentially above 10%. What about palate deformities, cleft lip and similar? Also requiring assistance and may experience flow preference or nipple confusion due to early bottle use. What about birth injuries? Strained neck muscles, sore heads, broken bones from bad labours, these may cause an infant to find breastfeeding painful and potentially traumatic. Are women and babies in these instance able to breastfeed?

What about psychologically able?

It’s an unfortunate aspect of our society that breasts are a very sexualized body part. So no wonder that some women find the idea of a baby sucking on a sexually objectified part to be a very uncomfortable one. If they can’t get their head around it or feel uncomfortable with the idea of breastfeeding are they truly able? Physically perhaps, mentally perhaps not.

And then we have the serious medical issues- strong medications required to keep the mother healthy, mothers who experience severe post partum depression or psychosis, post partum cardiac issues, not to mention high blood loss, postpartum hemhorrage and similar.

I guess saying some high number like 98%, 95%, most, nearly all etc is far more catchy and jingoistic than saying 85% of women will not face severe obstacles, unhelpful professionals (oh, that number just went down), supply issues, and even societal issues.

So next time someone says that, ask them, what do you mean by able?

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