Breastfeeding on demand: A cross-cultural perspective

© 2008 - 2014 Gwen Dewar, Ph.D., all rights reserved

Breastfeeding on demand—-also known as feeding “on cue” and “baby-led” feeding—-is about responding flexibly to your baby’s hunger cues. It means initiating feedings when the baby requests them, and continuing each feeding session until the baby is satisfied.

Evolutionary, cross-cultural, and clinical research suggests that babies were designed to feed on cue. For details, see my article on the scientific evidence for breastfeeding on demand.

Here I provide an overview of the benefits of breastfeeding on demand, and focus on the ways that new moms can cope with frequent, baby-initiated feedings.

Women living in Westernized, industrial societies face special problems that can make demand feeding more difficult. I discuss how babies are breastfed in other cultures and suggest how Western moms can apply these lessons to their own lives.

Why is breastfeeding on demand a good idea?

Breast milk production is keyed to the frequency of suckling. The more a baby nurses, the more milk a breast produces. If a baby suckles less frequently, milk production slows. For this reason, breastfeeding on demand is the ideal way to keep a mother’s milk production in sync with her baby’s needs.

In the first days of a baby’s life, cue feeding helps establish an adequate milk supply. It also helps newborns regain their birth weight more quickly. Moreover:

• Women’s breasts vary in the amount of milk they can produce at one feeding

• The caloric content of milk may vary by time of day and mother’s diet

• Babies vary in their ability to extract milk efficiently

• Babies also vary in their stomach capacities

Breastfeeding on demand permits babies to cope with the quirks of their particular situation. When babies are forced to adopt a rigid, timed schedule, some babies have difficulty getting enough to eat. In addition, lactation consultants often note that babies who are left to cry for access to the breast--even for a few minutes--may become unsettled and upset. This makes it hard for them to latch on correctly, decreasing the efficiency of their feeds.

For these reasons, baby-led breastfeeding is now recommended by:

• The World Health Organization

• The American Academy of Pediatrics

• La Leche League

Other reasons

The new pediatric recommendations seem inspired largely by concerns about milk production and early growth. But there may be other considerations. Breastfeeding soothes and reduces pain (Shah et al 2006). It provides babies with skin-to-skin contact—-a practice that promotes mother-infant attachment (Moore et al 2007) and helps regulate a baby’s body temperature and blood glucose levels (Anderson et al 2003). Skin-to-skin contact is also associated with higher rates of head growth in preterm infants (Rojas 2003).

Babies show signs of reduced stress while breastfeeding, and Kerstin Uvnas Moberg, an eminent physiologist and endocrinologist (MD, PhD), believes that breastfeeding bouts may boost babies’ levels of oxytocin—the “cuddle” hormone (Uvnas Moberg 2003).

As I note in this blog post, there is even evidence that rigid, scheduled feedings contribute to modest lags in cognitive development (Iacovou and Sevilla 2013). Why that might be -- energy shortfalls, stress, or other factors -- isn't yet clear.

But all this suggests that breastfeeding on demand may help babies regulate more than their caloric intake.

How often--on average--do babies feed?

As noted above, babies vary—both as individuals and across cultures. Hunter-gatherer babies nurse very frequently—-twice an hour or more. In the West, mothers who identify themselves as “baby-led” feeders may not nurse more than once every two hours. This disparity has led some researchers to question whether “breastfeeding on demand” means the same thing cross-culturally.

But regardless of the culture you live in, it seems clear that most babies need very frequent feedings only during the first weeks of life. When older, Western babies are permitted to determine their own feeding times, they usually settle into a routine of feeding sessions spaced several hours apart.

Coping with exhaustion

New mothers get precious little sleep and may find breastfeeding on demand to be exhausting. To a large degree, this is a transitory problem. As newborns mature, they are able to consume more milk at a feeding. They also become more “tuned in” to the rhythms of daily life. For these reasons, babies require fewer feedings overall-—and fewer night feedings—-as time goes by.

But knowing that your life will improve 4-6 weeks after birth doesn’t make the newborn phase less exhausting. And I think it’s fair to say that Western mothers face special problems that make breastfeeding more difficult. Here I review some of the cultural practices that help non-Western mothers establish and maintain breastfeeding on demand. These practices suggest ways that Western moms can make breastfeeding on demand easier.

Non-Western practices that support breastfeeding on demand

No punch clock

Our hunter-gatherer ancestors didn’t keep strict schedules. Neither have most people throughout human history. People have always had work to do, but they didn’t have clocks and their work-days varied according to the season and the tasks they had to perform. The idea of reporting to work each day at precisely the same time—and putting in the same, inflexible hours—is associated with Western industrialization.

New moms forced to keep a rigid schedule, restricting their sleep to certain night hours, adhere to strict deadlines and appointments, will obviously find it harder to make time for breastfeeding on demand.

Flexible sleep schedules

The Western model of sleep—-that you lie down at the same time each night and sleep for 7-8 continuous hours—-is another cross-cultural oddity. Anthropologists and historians have documented a very different pattern of sleep in other cultures (Worthman and Melby 2002; Ekirch). People who live without artificial light get more sleep overall. And people rarely consolidate their sleep into one long interval. Instead, they sleep for shorter intervals at different times throughout the day and night.

For instance, hunter-gatherers—-like the !Kung san of South Africa and Efe of Central Africa—-have no fixed bed- and wake-times, and people tend to nap opportunistically (Worthman and Melby 2002).

This opportunistic sleep style may be the norm for our species. And it is certainly more descriptive of how babies sleep than is the Western model.

Like the “punch clock,” the Western model of sleep puts parents at a great disadvantage. Western sleep schedules are relatively inflexible. If you miss the chance to sleep during the allotted hours, you are out of luck. Rigid scheduling prevents sleepless parents from making up lost sleep. This makes breastfeeding on demand more difficult, particularly in the early weeks when babies require frequent feedings.

Co-sleeping

Other peculiar characteristics of Western culture are solitary sleeping and the practice of leaving babies to sleep in cribs or cots. When babies and mothers sleep apart, night feedings become very disruptive. Typically, both mother and baby become fully aroused from their sleep, making it difficult for them to resume sleeping when the feed is over.

But in most non-Western cultures, people sleep with others (Worthman and Melby 2002). Infants are not left alone.

In a recent cross-cultural review of child care practices in non-industrialized societies, researchers found that babies shared beds with parents in 23 out of 26 societies surveyed (Severn Nelson et al 2000). An earlier, more extensive analysis of 90 cultures found no cases where mothers and infants slept in separate rooms (Barry and Paxton 1971).

When mothers and babies sleep together, breastfeeding on demand becomes much less disruptive to maternal sleep. This is particularly true when moms and babies sleep in the same bed. The baby awakens at night, and is fed right there—in bed—while both parties are lying down. The nursing couple need never wake all the way up (McKenna and Bernshaw 1995).

Baby-wearing

Westerners tend to “park” their babies in cribs, bouncers, car seats or playpens for much of the day. In the rest of the world, these practices are uncommon. Cross-cultural surveys reveal that most babies are held or carried throughout the day (Barry and Paxton 1971; Severn Nelson et al 2000). In hunter-gatherer societies-—and in societies found in warm climates-—“baby wearing” is further distinguished by skin-to-skin contact (Konner 2006).

As a result, mothers have more opportunities to “read” their babies’ cues, and babies are always close to the breast. In some cases, babies have easy access to the naked breast, permitting babies to begin feeding on their own.

Helpers

Unless they buy it, Western moms with infants receive relatively little help. New moms are frequently isolated from their extended families, and they lack close relationships with their neighbors. As a result, they may be cut-off from easy access to

• Breastfeeding advice

• Child-rearing advice

• Impromptu and emergency childcare

This means more stress and more work—and more difficulty breastfeeding on demand. By contrast, women living in hunter-gatherer groups—-and other, non-industrial societies—-receive substantial amounts of help. In one hunter-gatherer society (the Efe of Central Africa) this help extends so far as to include women who provide supplemental breastfeeding to other women’s newborns (Tronick et al 1987)! For more details, see this article about non-maternal helpers.

Postpartum seclusion

In a wide range of places, from Southeast Asia (Jambunathan 1995), to China (Raven et al 2007), to Morocco (Westermark 1926), mothers may spend the first 30-40 days weeks with their newborn in postpartum seclusion. During this time, mothers are excused (if not downright forbidden) from doing most work except for breastfeeding. Friends or relatives (usually the mother’s mother or mother-in-law) help with housework and food preparation.

Postpartum seclusion isn’t necessarily a picnic. Cultures may impose rituals and taboos that mothers may find restrictive (Leung et al 2005). But the help mothers receive probably makes breastfeeding on demand less difficult.

Acceptance of public breastfeeding

For Western moms, breastfeeding on demand is particularly difficult when they leave home. Many Westerners are uncomfortable around breastfeeding, and few public places provide space for mothers to breastfeed discreetly.

The problem seems to stem from Western sexual attitudes. Westerners may take it for granted that the breast is an object of erotic interest. Breastfeeding therefore seems a bit risqué. But there is nothing natural about this association. In most cultures, breasts are viewed in terms of their primary function: organs for expressing milk. In one cross-cultural study, breasts were considered sexy in only 13 out of 190 cultures surveyed (Ford and Beach 1951).

Anthropologist Katherine A. Dettwyler argues that American attitudes toward breastfeeding are heavily influenced by the notion of the “sexy” breast. In her excellent paper, “Beauty and the breast: The cultural context of breastfeeding in the United States (Dettwyler 1999), Dettwyler contrasts American attitudes with those of several non-Western cultures. In places like Mali or Nepal, women’s breasts are not sexualized, and women nurse their babies in public whenever the baby is ready to feed. There is nothing sexual—and nothing embarrassing or awkward—about it.

Breastfeeding on demand: Making it work

Western attitudes and cultural practices may not be particularly supportive of breastfeeding on demand. But understanding how breastfeeding works in the non-Western world suggests ways that Western mothers can better cope. See these tips for improving your breastfeeding experience.



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References: Breastfeeding on demand

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Content last modified 2/2014