Using language to facilitate breastfeeding

By Keren Epstein-Gilboa PhD, MEd, BSN, RN, FACCE, LCCE, IBCLC, RLC

Language Facilitating the Establishment and Maintenance of Physiologically Based Breastfeeding Patterns:

  • Uses breastfeeding as the term of reference (Weissinger, 1996). Language should indicate that breastfeeding is a normal physiological and psychological activity essential for human development.
  • Demonstrates an awareness of the effects of a predominantly non-breastfeeding environment on language and disregards non-breastfeeding-supportive terminology.

Underlying Principles:

  • Ethical – Practitioners have the obligation to provide clients with accurate, evidence based and truthful information in order to facilitate the task of informed decision making.
  • Educational – Clients have different learning styles and abilities. Learning interests vary according to developmental stages and state of readiness to internalize novel concepts.
  • Psychological – Clients strive to be normal and “good enough” – not “better than”.
  • Physiology and Psychology of Breastfeeding – Nursing is an essential developmental task – inclusive of specific behaviours and physiologically based patterns – that facilitates normal psychological and physiological development.
  • Pathology of NOT nursing – Veering from physiologically based nursing patterns may impair normal health and development.
  • Ecological – Concepts and behaviours associated with breastfeeding are influenced by and affect interactions with a large system. The predominant systemic messages convey that artificial feeding is normal and breastfeeding is the exception. Marketing Strategies used to sustain this message include: validating families’ desire to be normal not exceptional, presenting nursing and artificial feeding are two feeding choices, and using artificial feeding as the term of reference when talking about breastfeeding.

Applying Guidelines and Principles to Practice

Letting go of Language that Interferes with Breastfeeding:

  • Stop using artificial baby milk as the term of reference. Breastfeeding is the norm. Using artificial feeding as the term of reference reflects the dominant non-nursing culture.
  • Don’t use superlatives to describe nursing, including “better”, “the best” or “ideal”. Instead refer to nursing as normal and essential. Breastfeeding is the norm, it is not better than the norm.
  • Avoid comparing the advantages and disadvantages of breastfeeding, implying that nursing is a product. Instead, present factual information about breastfeeding.
  • Don’t speak of breastfeeding as a “choice” that indicates that nursing is equivalent to another product. Breastfeeding is an essential physiological and psychological experience not a product.
  • Don’t isolate breastfeeding. Nursing is part of a developmental continuum.
  • Refrain from detaching pregnancy and birth from breastfeeding. This action ignores the impact of birthing on breastfeeding and mothering, impairing the ability to make well informed decisions.
  • Don’t disregard the multiple functions and implications of breastfeeding. Breastfeeding is a multifaceted behaviour, developmental task and relationship and experience.
  • Avoid using terms that such as feeding, feed, food, hunger in reference to nursing. These terms are confining and imply that nursing is primarily a means of feeding. This impairs parents’ capacity to answer cues. Some parents will ignore cues for comfort if they feel that the baby has “just fed” or has eaten enough.
  • Don’t talk about the anatomy, physiology and mechanics of breastfeeding using non-nursing as the term of reference.
  • Refrain from focusing on the nipple when the breast is central to nursing.
  • Avoid quantitative measures, including the quantity of milk or length of time in between or during nursing sessions. This act contradicts the encompassing nature of nursing. Instead teach parent to assess the quality of nursing including suckling and infant/child cues.
  • Don’t make judgments based on erroneous and non-nursing focused information, such as, “Your nipples are too small for breastfeeding” or “Breastfeeding is exhausting.”
  • Don’t hide or apologize about physiological nursing patterns including, early initiation, the period of nursing exclusivity and breastfeeding into early childhood.
  • Refrain from using terms that pathologize the natural continuum of physiologically based nursing patterns. For example terms such ‘extended nursing’ – sometimes used to describe nursing beyond infancy – imply that this type of nursing is too long.
  • Don’t imply that distal strategies are the norm for parent child interaction. Physiologically based nursing is associated with proximity behaviours.
  • Don’t withhold information from families or support deviations from physiology such as early supplementation. This is disrespectful, condescending and violates the principle of providing accurate information required for informed decision making.
  • Let go of misconceptions that appropriate language may cause guilt. Guilt is a human emotion owned by the bearer and stems from internal processes, not by others.
  • Don’t call breastmilk substitutes by names that promote marketing. This act may interfere with optimal internalization of nursing as the norm. For example, the term “formula” wrongly describes artificial baby milk as a scientific and perfect product.

Practical Ways of Using Supportive Language:

Breastfeeding is normal, natural physiological and psychological experience.

  • Use nursing as the term of reference (Weissinger, 1996). Indicate that breastfeeding and physiologically based breastfeeding patterns are normal, natural and essential for normal growth and development.
  • Describe breastfeeding using terms that reflect the underlying physiological principles and behaviours associated with breastfeeding, such as “physiologically based nursing patterns”.
  • Explain that breastfeeding is part of the normal developmental continuum.
  • When discussing the physiological continuum emphasize issues associated with the learner’s developmental stage. For example, prenatal discussions may mirror the focus on maternal- foetal development by demonstrating how maternal infant symbiosis in utero is similar to maternal infant interdependence in the post partum period.
  • Talk about the connection between the birthing experience and breastfeeding.
  • Describe the long and short term impact of breastfeeding on children’s, mothers’ and father’s normal physiological and psychological developmental trajectory. Convey that breatfeeding is an essential and normal factor affecting development.
  • Describe the role that the breastfeeding relationship plays in family development.
  • Talk about the encompassing nature of breastfeeding, including descriptions of the physiology, psychology and emotionality of breastfeeding.
  • Use terms such as nursing to delineate the nurturing aspects and relationship to emphasize the bidirectional components of breastfeeding.
  • Describe anatomical and physiological mechanism of breastfeeding in a manner that reflects its physiology. For example, talk about the breast rather than the nipple.
  • Talk about nursing sessions rather than “feeds”.
  • Measure the quality of the breastfeeding relationship in terms that demonstrate an understanding of the encompassing physiological and psychological processes. Focus on the characteristics of nursing rather than external measurements of quantity. For example, discuss the quality of the infant’s suckle rather than the amount of milk the baby is drinking.
  • Describe the normal physiologically based breastfeeding continuum with confidence.
  • Refer openly to nursing exclusivity and breastfeeding into early childhood.
  • Discuss parenting strategies that facilitate nursing, including cue reading and proximity behaviours.
  • Present proximity strategies: carrying, holding, co-sleeping and child focused weaning as normal and essential.
  • Discuss the risks of not nursing and veering from normal nursing patterns. Remember the obligation to provide information facilitating informed decision. Families have the right to know that veering away from physiology has pathological consequences.
  • Use real names for artificial feeding, and synthetic feeding and calming devices. Define products in a manner that describes their true nature, purpose and ill effects.

References and Interesting Resources

  • Baumslag, N, & Michels, D. (1995). Milk, money and Madness: The culture and politics of breastfeeding. Westport, Connecticut: Bergin & Garvey.
  • Epstein- Gilboa, K.(2010). Breastfeeding envy: Unresolved patriachal envy and the obstruction of physiologically based nursing patterns. 2010. A. Bartlett & R. Shaw (Eds.) In Giving milk. Toronto: Demeter Press.
  • Epstein-Gilboa, K. (2009). Interaction and relationships in breastfeeding families: Implications for practice. Amarillo Texas: Hale Publishing.
  • Epstein-Gilboa K. (2001).Using language to facilitate breastfeeding. Retrieved Jan.28, 2010 from, http://www.infactcanada.ca/Using%20Language%20to%20Facilitate%20Breastfeeding%20by%20Keren%20Epstein%20Gilboa.pdf
  • INFACT Canada. (2010) actions, fact sheets, newsletters, and links. Retrieved Jan. 28 2010 from, http://www.infactcanada.ca/
  • Minchin, M.(1998). Breastfeeding Matters. Australia: Alma publications.
  • Newman, J. (2000). Breatsfeeding and guilt Retrieved Jan. 28, 2010 from, http://www.mamadearest.ca/en/info/newman/guilt.htm
  • Palmer, G. (2009). The Politics of Breastfeeding :When Breasts are Bad for Business. London UK: Pinter and Martin.
  • Wiessinger D. (1996). Watch your language. Journal of Human Lactation. 12(1):1-4.

Fact sheet updated from original 2001 version, Using language to facilitate breastfeeding.

Read the author’s book: Interaction and Relationships in Breastfeeding Families.