(Presented 16th June 2012. Birmingham)

My background is in primary school teaching and, as a Year Six teacher and Deputy Head, I was responsible for the delivery of the Sex Education curriculum. My embarrassment threshold is HIGH when it comes to talking about sex, which is certainly useful for the purposes of this study and talking about it in front of 120 or so people.

What inspired me to look at this topic in the first place was a conversation I had on the phone with the mother of toddler still breastfeeding at night. She was explaining that night feeding and co-sleeping was beginning to impact on her relationship. And in a millisecond I made a whole bunch of assumptions. I thought that perhaps she was getting pressure from her partner; that he was unhappy about the lack of sex but maybe she would have been happy to continue with the current situation. A whole bunch of assumptions arose from personal experience, cultural messages and who knows where. But it turned out she was miserable as they were only managing to have sex 2 or 3 times a week and this push was absolutely and definitely coming from her.

I wanted to explore how women were balancing their roles as a sexual partner and a breastfeeding mother. I wanted to look at the experiences of breastfeeding mothers and find out more about the variety of experience. I looked at parenting forums. I read books aimed at new mothers like Gina Ford’s ‘The Contented Mother’. I read about the Gogo women of Tanzania and swapped emails with a doctor working in Papua New Guinea.

I thought my talk was going to be about how breastfeeding changes sex.

But the more reading I did, the more I became convinced that the crucial issue is not how breastfeeding changes sex but how attitudes to sex in our society impacts on breastfeeding. How sexualisation in our society impacts on the work we do, how it impacts on the choices mothers make —to feed in public, to continue breastfeeding, to exclusively breastfeed, to breastfeed once back at work.

And if we are to increase initiation rates among certain groups —women under 20 for starters— we need to understand the fundamental role sexualisation has to play.

We live in a society which has lost sight of the primary function of the breast.

We live in an extraordinary culture in extraordinary times. 

Spend time looking at our society’s perception of breasts and messages about breasts and it’s frankly surprising our breastfeeding initiation rates are even what they are. The 2010 UK infant feeding survey preliminary results show they are up to 81%.

However if look further, and these results are from the 2005 survey, we have 45% exclusive breastfeeding at 1 week, 3% exclusive breastfeeding at 5 months. At 6 months, only 25% are doing ANY breastfeeding.

Yes, it’s about lack of support to breastfeed, lack of information, lack of good quality antenatal education, overstretched hospital-based and community-based healthcare professionals, lack of breastfeeding knowledge from doctors. It’s about many many new families simply not knowing why exclusive breastfeeding is recommended ahead of any breastfeeding. 

It’s about all that. 

But I’m also going to argue that the significant drop-off as we approach 6 months is also about women struggling to integrate their roles as a breastfeeding mother and a sexual partner, or even a woman, in this society.

In our society, the nuclear family is on a pedestal. It’s isolated and centralised. The couple is the focus. The extended family, as we hear so often, is largely a thing of the past for most families living in the UK. The average working father who has 2 weeks paternity leave and then returns to employment, who may have very few other new or changed relationships or links to the ‘baby world’, comes home to this central relationship. And the strong message is that a successful relationship is a sexual one.

As breastfeeding professionals and support volunteers, we’re used to debriefing our breastfeeding our breastfeeding experience. But when it comes to sex and libido, a discussion is not encouraged.

We may assume our experiences are normal. But we need to reflect on the variety of experiences women have. The new mother not feeling sexual may feel pressured and uncomfortable but my survey revealed just as isolated is the sexual breastfeeding mother – one described herself as a ‘freak’. Is society comfortable with a woman who is simultaneously breastfeeding and sexual? Are we allowed to talk openly about that integration?

When we talk to mothers about co-sleeping, decisions to wean, evening cluster feeding and the 4 month sleep regression – how often might sex be an unspoken part of that conversation?

As breastfeeding supporters we often think it’s living in a bottle-feeding culture that makes our work hard - the dolls that come with toy bottles while a doll marketed as having any connection with pretending to breastfeed is more likely to provoke an article in the Daily Mail. Formula companies pour money into marketing their products right up to the limits of UK legislation and often beyond. Pregnant mums are signed up to clubs - and logos and images from formula companies get into their homes and their consciousness. Formula companies offer ‘information lines’ or promote forums. Pre-schools may remove feeding bottles from home corners these days but no conversation occurs of what norms of feeding are so children simply pick up glue sticks and continue ‘bottle feeding’. 

As Kathy Abbott mentioned in her presentation at the Gold conference this year, bottle feeding does fit with our culture – a culture that values privacy, control, measuring, and compartmentalisation. And when only 25% of mothers are doing any breastfeeding at 6 months, this is not just about perceptions of cultural norms. This is about actual norms. 81% of mothers initiate breastfeeding but that may only be a lick of a nipple in hospital. Something else is happening in the weeks that follow. When mothers get a baby home and live their relationship with their post-natal body surrounded by our culture, something is going on. Women are making feeding choices based on cultural messages about sex and their bodies and womanhood. 

If we can’t necessarily control these messages, at least we can encourage a dialogue about them.

Our society bombards us with images of the female body. The rise of the celebrity magazine is a phenomenon of the last decade where body fascism has been taken to new levels. Women are celebrated for weight loss – but you can’t be too thin and unfeminine and they vilified in the next breath if an inch of stomach flops over the top of bikini bottoms when an individual sits down. The window of ‘acceptability’ seems frighteningly narrow. There are television programmes about looking good naked, having embarrassing bodies and the reality show with groups of young women largely defined by their surgery. The perfect female body is expected to have ‘tight abs’ and the sexy rounded stomach of Marilyn Monroe is a distant memory.

The overriding message is that breasts are for male attraction and female bodies are for male attraction. As breastfeeding advocates, we write our letters about misleading formula advertising but we also need to understand that our work is also influenced by the rise of the photo-shopping, body image obsession.

When women fall pregnant, we expect them to make a dramatic mental shift. We expect their partners to make a mental shift and reject decades of messages about what the breast is for - men who like no other generation before have been exposed to images of the sexualised breast through easy access to pornography, advertising and celebrity.

And we ask women to feed exclusively for 6 months or to 12 months and beyond. While at the same time, even those of us working in breastfeeding support do not openly talk about how to incorporate sexuality and breastfeeding.

We ask them to make this dramatic shift on the basis of some colourful leaflets often lacking in evidence-based detail, some conversations with overworked healthcare professionals and a newspaper industry that relishes an opportunity to debunk the breastfeeding ‘myth’. 

How many antenatal classes ask new parents to reflect on breastfeeding and sexuality? And in how many classes are teachers terrified to dwell on a topic that might be seen as ‘difficult’ when the focus is on desperately encouraging new parents to consider breastfeeding? The new government programme of antenatal parenting classes (‘Pregnancy, Birth and Beyond’) does touch on some interesting feeding issues such as the risks of formula. It also asks parents to consider the impact of parenthood on their relationship.

It would be nice to imagine at some point, we could talk about sex and breastfeeding. The sum total of information currently seems to be ‘if you’re worried about leaking during sex, you can wear a bra and breast pad’. But what if you’re not worried about leaking? What if your partner likes it? What if he’s struggling with the image of breastfeeding in general? Is he allowed to talk about that and say that out loud? Who can these couples talk to?

Is anyone sitting around with a group of new fathers and asking them why oral sex might be acceptable but a taste of breastmilk is a difficult thought? These are conversations that need to be had.

Think about the teenage mum born in the mid-1990s. What messages have she and her partner received about breasts their entire lives? We often remark that those working with teenage mums will need to anticipate they are likely to have more body issues. But perhaps we can’t assume this current generation will ‘grow out of’ these messages. Maybe if we don’t start to reflect on the implications of the new body image obsession for breastfeeding, a dip in breastfeeding rates is ahead as these women enter their 20s and 30s.

So how do breastfeeding women feel about sex and how can we find out? We need to remember that the population of breastfeeding counsellors and supporters is unlikely to be representative of all women who breastfeed. Most of these women will have fed for a minimum of 6 months in order to undertake training with a breastfeeding organisation. Perhaps these are the women who did ‘integrate’ those sides of womanhood. Maybe they rejected the cultural norm and embraced the biological one.

Or perhaps we didn’t. Perhaps we didn’t manage to be simultaneously breastfeeding and sexual. Perhaps breastfeeding just mattered to us more and we stuck it out.

I carried out a survey of 588 women. They largely came from Twitter, mumsnet and netmums. It’s probably true that if you are struggling to feel sexual the appeal of answering questions on some lactation consultant woman’s bloody survey is small. I tried to make this point and certainly some of the women struggling did come through.

It’s also the case that a high proportion of natural term breastfeeders came through and immediately this means the survey cannot be representative of breastfeeding mothers as a whole— that world where only 25% are doing any breastfeeding at 6 months. The survey is not a great truth but it did throw up some interesting points.

I asked mothers, ‘when did you first have sex after the birth of your last baby?’

If you are a breastfeeding mother reading this, what’s your answer to that question?

How do you anticipate the 588 mothers answered? Do you think you were typical?

It’s clear that for the breastfeeding mothers responding to my survey having sex under 3 months was normal. And in fact having sex under 6 weeks is pretty normal.

Of course, this doesn’t tell us under what circumstances this sex occurred. Was it enthusiastic or dutiful? One mother contacted me to explain how concerned she was about the phenomenon of health care professionals advising couples to have sex before the 6 week check to ‘test things out’. She was considerably damaged by her birth and followed her instincts not to try, despite a strong urging she should. I wonder how many others don’t follow their instincts.

My survey population were breastfeeding for a long time. Huge numbers were breastfeeding for 24 months plus. Half of respondants had fed for more than 18 months. Perhaps these are the women with the partners who either value breastfeeding enough to tolerate what they’re not comfortable with or they are comfortable —and these women can be simultaneously sexual and breastfeeding. They are rejecting the cultural ideal of the non-sexual mother of an infant. 

This amount of variation was also reflected in Ann Sinnott’s results when she did her own survey for her book, “Breastfeeding Older Children”.

When Alfred Kinsey undertook his research on female sexuality in 1953, 50% of women enjoyed breast stimulation. However 98% permitted the touching of breasts and 87% permitted oral contact. 

It’s interesting therefore that some of society’s discomfort around breastfeeding – and breastfeeding older children especially – is the perception that the act itself is a sexual act. Not only is that untrue, research suggests that even if George Clooney was involved it wouldn’t automatically be a sexual experience for the woman.

Are women tolerating breast contact or even sex unhappily? Are they dutiful wives forcing themselves to get ‘back in the saddle’? Are they having some sort of ritualistic sex to prove something almost as the Gogo women of Tanzania have a ritual act of sex between 3 and 4 months post-partum (and then they remain celebate for the rest of their breastfeeding experience).

Are women with biologically low libidos having dutiful sex?

I think those results would challenge the notion that these are women reluctantly having dutiful sex.

The open-ended questions revealed a huge variety of feelings about sex and body image. Some women felt empowered and came alive with breastfeeding, after decades of perhaps feeling negatively about their bodies. Others were feeling self-conscious and uncomfortable.

I aksed the question, ‘How has being a breastfeeding mother affected your self-image and feelings about your body?’

Among the huge variety of comments given were these:

“Although my OH finds my changed figure wonderful, I am far less confident in the initiation of sex and also (sorry if TMI) I am limited in choosing different positions due to leaking. Niiice :)”

“Given me confidence in body’s ability, which has knock on benefits for sex. LOVE my bigger boobs!!”

“We usually have intimate time soon after baby goes to sleep. I usually nurse him to sleep so my breasts look ‘deflated’ and I usually feel too self-conscious to let them hang down, so I prefer to lie-down or keep a shirt on.”

“It has de-sexed my breasts.”

“I want to continue bf but my husband is desperate for me to stop.”

“I am here as a carer, not a lover right now.”

The impact of breastfeeding was often over-shadowed about a mother’s views about her general post-natal body. Many women commented on feeling self-conscious about their stomach area or their weight gain. This is also often reflected when you talk to new mothers self-conscious about feeding in public. If the concern is about nudity, it’s often not about breast exposure but ‘belly’ exposure.

I asked women about their libido.

We’re often quick to think libido is about biology and hormones. We talk about how lower oestrogen levels affect vaginal lubrication. Or how libido might be impacted by an overabundance of prolactin ( a theory mentioned by Ann Sinnott). Clearly it’s difficult to separate factors and new mothers themselves can’t. 

However if only 3% are exclusively breastfeeding at 5 months, are depressed oestrogen levels continuing as an issue for many? And if you are breastfeeding beyond 18 months, prolactin levels are not likely to be remaining at a constant elevation.

It appears to be coming back to culture again. Surely repressed libido levels are also about women not seeing themselves as sexual while they are breastfeeding. They are not fitting society’s ideal of sexually attractive woman. A society that values the non-functioning breast.

These days it appears that for many, the augmented breast is the ideal breast and its purpose is to attract the male gaze.

This year marks the 50th anniversary of the first ever silicon implant surgery in Houston, Texas. Augmentation surgery costs approximately £4000 and implants last around 10-15 years. It’s the most common breast surgery with women making up around 90% of the population having cosmetic surgery. 

Obviously there are women who use implants in reconstructive surgery and women with severe asymmetry who feel augmentation surgery is hardly about trying to look like Pamela Anderson. But for the majority of women, this is about feeling inadequate with their natural breast size and feeling society expects them to look different.

From 2009-2010, augmentation surgery was up 10%.

From 2002-2007, it was up 275%.

(http://www.guardian.co.uk/news/datablog/2012/jan/30/plastic-surgery-statistics-uk)

Rajiv Groover, the secretary of BAAPS (British Association of Aesthetic Plastic Surgeons) feels this is down to ‘raised awareness of the procedure and media exposure’.

In our current society, the separation of the breast and its biological purpose is pronounced. While it’s true that many women with implants go on to breastfeed successfully (Pamela Anderson among them), if you look at the literature given to women prior to surgery this is barely mentioned by clinics and organisations and sometimes breastfeeding gets NO mention in a leaflet focusing on breast surgery for pre-menopausal women. Some procedures may leave ducts intact but damage occurs to the fourth intercostal nerve with incisions that impact enormously on successful breastfeeding as the milk ejection reflex and release of oxytocin hormone is hindered.

Ironically, if we study the shape of the augmented breast it is an engorged and full breast that very much resembles the breast of a new mother. This is the sexy image. 

Picture Pamela Anderson running slo-mo down her Californian beach. 

But the moment we add a drip of milk to that breast, it is immediately desexualised for the vast majority in our society (expect for the small group who reach my blog using certain search terms – you know who you are). The sexy breast is overwhelmingly the non-functioning one.

We may think, ‘Oh come on! Surely men are attracted to that type of breast precisely because it suggests fertility and provision of milk? Aren’t they just all cavemen looking for successful mates?’ That isn’t the case.Cultures vary enormously in their attitude to breasts and for many the breast simply isn’t sexual. Kathy Dettwyler in her essay, ‘Beauty and the Breast: the cultural context of breastfeeding in the U.S’ published in the wonderful book, ‘Breastfeeding: Biocultural perspectives’ emphasises the fact that this is not the default setting for all human beings.

In the 1950s, the anthropologists Ford and Beach studied 190 cultures worldwide. Of those 190, 13 found breasts sexy. 

9 liked large. 2 liked long and pendulous and 2 liked upright and hemi-spherical.

I had an interesting chat with ABM mother supporter, Yolanda Forster, who is originally from Belize and remembers from her childhood, women from Southern Belize with exposed breasts who only covered up as the roads going South became paved and social mobility increased. Even today she feels that breasts are not the ‘big deal’ for many Belizeans that they are in other Western cultures and breastfeeding is the norm.

The battle to integrate the dual functions of the breast is not being fought universally.

Kathy Dettwyler says, “Most Americans view Chinese foot-binding as the barbaric practice of backward people. Yet breast augmentation surgery is essentially the same thing. A perfectly healthy, functional organ, the breast, is mutilated through surgery into something useful only for male sexual pleasure.”

And, as she points out, if a cultural view exists that breasts are primarily sexual objects this impacts on whether older children receive breastmilk, whether public feeding is acceptable and the compatibility of breastfeeding and the workplace. Do women feel comfortable discussing a topic potentially laced with sexuality with their employers and colleagues and bringing something ‘intimate’ into their place of employment?

As Kathy Dettwyler suggests, the realistic aim is not about to be asking everyone to suddenly stop finding breasts sexy. However it’s useful to recognise this as a cultural attitude if the biology is at least going to get a look in.

A leaflet in pregnancy about how lovely breastfeeding is and with references to reduction in ear infections and hospitalization is unlikely to win over decades of social conditioning.

We know that culture is bombarding us with messages about body image and attraction. If you look at the government inquiry into body image last year led by Jo Swinson m.p. and the research being done at the University of the West of England, Britain’s body image is in crisis.

We all tut when we hear of 5 year old girls worrying about being fat. Or we see the bikini tops marketed at 3 year olds.

But consider the implications for breastfeeding in decades to come. Currently, half of all 16-21 year olds would consider cosmetic surgey (University of the West of England research).

There’s a world of ‘fat talk’ where being feminine means control over food. When slim is the aim and the ideal and flat ‘abs’ is increasingly a focus, the post-natal woman is likely to feel excluded. And when overall weight loss occurs, breasts often diminish so augmentation becomes more of a requirement for many women wanting to attain the ideal body shape.

Susie Orbach wrote ‘Fat is a Feminist Issue’ in 1978. She’s currently working on a research project on the transmission of body image from mothers to daughters. She’s pushing for midwives to get involved. She says, “New mums are caught up in problems with their own bodies when they’re bringing a new body into the world. We need a counterpoint to the nonsense that we should have a pre-pregnancy body 6 weeks after having a baby or ever.”

(http://www.guardian.co.uk/lifeandstyle/2012/jun/10/body-image-anxiety-eva-wiseman)

When it comes to considering the forces against women breastfeeding to 6 months, it’s also worth mentioning a theory put forward by a man called John W. Travis and others. This theory is also touched on by Ann Sinnott in ‘Breastfeeding Older Children’. It’s one of those theories that makes for uncomfortable reading. It makes most of think, ‘mmmmm…uhhhhh…rrrreally?’ but it’s worthy of mention.

The theory suggests that the current generation of daddies of breastfeeding babies largely grew up in the 1970s and 1980s and were unlikely to have been parented according to the biological norm. This may impact on their ability to accept their sexual partner as a breastfeeding woman.

In his essay, ‘Why men leave – a hidden epidemic’ (2004), Travis states: “As infants, most men in our culture have been bottle fed and subjected to other culturally-endorsed patterns of normative abuse, such as sleeping alone or being left to cry when their needs weren’t met. It’s no surprise, then, that most of the unbonded boys in our culture grow into men who spend a good deal of their time unconsciously seeking (and fueled by advertising that prominently features the breasts they were denied) a mommy-figure to provide them with the nurturing they were denied. ..When our “mommy” gives birth and suddenly turns her focus toward her newborn, we usually lose much of the nurturance we were getting from our partners.”

Mmmmm…uhhhh…really?

It’s a possibility.

A Breastfeeding Network supporter made an interesting point to me at the ABM conference. She suggested that perhaps this sometimes comes down to whether women feel that sex is about ‘giving’ or receiving. If a woman ends a day feeling ‘touched out’ and feels that sex is yet again about meeting someone else’s needs and giving yet more – that feels very different than if sex is a time ‘for her’. For some women, sex will be a time to feel pampered, loved, cared for. Not a time to do yet more ‘giving’ but a time for loving ‘receiving’. So perhaps the couples that move forward with successful integration are simply the ones where the men are better lovers and better communicators and better at being skillful smooth operators?

Too cheeky?

The breastfeeding supporter didn’t mean to make an overly-simplistic point. She was just touching on the idea that couples who already possess a healthy mutual communication around sex are likely to find this period easier. Of course, we need to be sympathetic. Men struggle during this time too. My survey identified many couples where a woman was feeling confused and rejected and as with women struggling with sex, men can struggle for a host of different reasons. Sometimes women in the survey were feeling desperation and described how their husbands were uncomfortable about their lactating breasts or their change in body shape. How new fathers feel about sex in the post-partum period needs to be examined in more detail and can really only be touched on in this discussion. My work also failed to examine the impact of breastfeeding on lesbian couples.

One thing that seems to come across strongly is that young men and women often struggle with the notion of the lactating breast before they become parents themselves.

The discomfort around breastfeeding in public and the ‘ewwwwww!’ factor that surrounds breastfeeding isn’t always to see. As with racism, MOST people who are revolted by breastfeeding understand this is perhaps not the modern acceptable view so tend to express their views in private or unconsciously or quietly. 

However this is when social media can be useful because people see breastfeeding in public, have an immediate and visceral reaction and pick up their smartphones to express it, often imagining they are tweeting quietly to their friends.

The number of people who misunderstand that Twitter is not a private forum is rather sweet and for these purposes, quite useful.

And hats off to the breastfeeding supporters (such as @Wolf_Mommy) who trawl through Twitter and try and engage with some of these people. They are often young men and women in their late teens and early 20s:

@onyx918 I don't think there is anything normal about having any of my children sucking out anything that i put into my body.

@deonmcallister still can't get over that lady breast feeding in the library today, WHO IN THE RGHT MIND WOULD WHIP A TIT IN THE LIBRARY OF ALL PLACES!

@mariahurtado92 So I came to drink my shake and there this women breast feeding her child #ewww

@_MizJohnson Is this lady really breast feeding in our restaurant!!!!!!?????!?!?!?!?! @ the table too!!! That's what we have a bathroom for! #ClassLESS

There is a common view that a toilet is the place to feed an infant. But even women feeding their children here can’t win:

@booboo_92 This is why I hate public restrooms. I do not need to see you breast feeding your infant child!!! Ughh.

When these tweeters are challenged, they often talk about their preference for mothers to use formula or to cover up or for mothers to pump their milk and use a bottle.

The power and rise and development of the electric breast pump may have done us no favours in this arena. It removes the oral contact which for many is the area of discomfort. And in a society where campigns often revolve around the benefits of ‘breastmilk’ (see New York City currently), technology may not be our friend in this battle.

Our society is confused. While the couple is prioritised and sexuality is key, we also promote the desexualised view of motherhood. Can you be a ‘yummy mummy’? Yes, if you fulfill certain criteria. Can you be sexy WHILE you are breastfeeding? In that moment? Just as in Papua New Guinea and among the Gogo women of Tanzania, we are desexualised during breastfeeding. Women are supposed to be a functional part of a couple but they are expected to put their sexuality in a little box. They need to compartmentalize themselves. One minute they are the mother figure. When the baby is away from them, they are allowed to switch on the other type of ‘Madonna’. There are no Mother and Baby magazine articles on breastmilk and foreplay. There are no open discussions about breastfeeding and sex. One mother confided to me that she and her husband had on occasion been having sex while she was breastfeeding her infant. That concept would provoke a strong reaction for many. We need to think more about why? Would a mother even be ‘allowed’ to look lustfully at her partner while breastfeeding or use sexual language? That doesn’t follow the expectation of compartmentalization.

Sometimes women who are not feeling sexual during motherhood are told to ‘grin and bear it’. This is a phrase actually used in the ‘The Contented Mother’s Guide’ by Gina Ford. And several mothers quoted in the guide talk about using wine to force themselves back in the saddle. Women are encouraged to switch off certain sides of themselves while at the same time feeling a pressure to meet society’s expectations of successful coupledom.

If you google ‘nursing bras’ and look at the images that appear, the image is of a lingerie model seductively opening her strap clasp with the wind machine in her hair and fully made-up. She’s still doing her sexy model thing. Would she be allowed to look like that if there was a baby sitting on her lap?

On one web page about electric breast pumps, we find a woman gazing seductively at her Medela pump. If there was milk in that collection bottle, would she be allowed to look like that?

And while you are opening internet windows, remind yourself of the 2012 Time magazine cover to feature breastfeeding: "Are You Mom Enough?".

The woman who doesn’t put herself in a box and doesn’t compartmentalize, who is sexually ‘integrated’, pushes a lot of buttons. Imagine if this woman wasn’t staring out at us with that gaze, if she was wearing loose and unfashionable clothing, if her hair and face was different. What about if she was breastfeeding a baby but still looked like that and looked out at us like that?

As another tweeter @sassycrass says, “It’s not a woman’s nudity that upsets you. Nope. It’s her liquid movement from the realm of the sexual into the realm of the maternal and back, if and when she wants.”

If the compartments were broken, if bras and breastpads came off in the bedroom, if breastmilk and sex wasn’t icky, what would the power of woman be? What couldn’t she do?

Some ‘take home messages’:

1. Breastfeeding affects sex but perhaps more significantly - our society’s thinking about sex affects breastfeeding. Things going on in bedrooms are affecting breastfeeding and it’s time to talk about it.

2. Breastfeeding supporters may need to be some of those people having those conversations and we may need to start by reflecting on our own experiences of sexuality and breastfeeding.

3. Antenatal education needs to be a time when honest conversations about sex can happen. Talk about the sexualisation of the breast. Look at advertising images. Have father-only chats. Talk about tasting breastmilk and fears and how we might be getting to 6 months happily.

4. Discussions with our daughters (and sons) about photo-shopping and body image is not just about their self-esteem or whether they might end up wanting cosmetic surgery, it’s about making a future generation of breastfeeding women and father who support them. A crucial element is how we talk about our own bodies in front of our children. We are role models. The charity ‘Media Smart’ has just launched a parent pack aimed at supporting parents in the conversations they have with their children about body image. You can download the pack here

Appendix:

And while we’re talking about sex perhaps we should also talk about supporting breastfeeding women with contraception.

As breastfeeding supporters, we often feel that it’s important that breastfeeding women understand the value of L.A.M (Lactational Amenorrhea Method). If women are feeding a baby under 6 months and their periods have not returned and they are feeding regularly throughout a 24 hour period (at least every 4 hours in the day and every 5 hours at night), then breastfeeding alone is considered as a method of contraception of around 98% effectiveness. 

Of course, if only 3% of women are exclusively breastfeeding by 5 months, these conditions may not be applying to a large volume of women.

And for many women who have spent a lifetime worrying about unwanted conception, there may be psychological barriers to trusting this method alone. 

Most women understand that hormonal contraception containing oestrogen is regularly connected to a diminishing milk supply. Progesterone is also anecdotally connected to supply problems but it’s important to understand this is only anecdotal and provided a mother is 6 weeks post-partum, there isn’t evidence to suggest progesterone-based contraception is routinely a problem for breastfeeding women. If there is concern, a possibility is to trial a progesterone contraceptive pill and provided there are no issues, a different method such a the depo-provera injection or implant is a possibility. The Mirena coil delivers a localised dose of progesterone to the uterus and seems less of a concern in these anecdotal reports.

Emergency contraception is also available to breastfeeding women. The Levonelle emergency contraceptive pill is licensed for breastfeeding women and can be used up to 72 hours after sex. A copper IUD can also be inserted up to 5 days later.

For some women, the issue is not trying to avoid getting pregnant while breastfeeding but a strong desire to conceive again without ending a breastfeeding relationship.

This is likely to become even more of an issue as the average age of motherhood continues to increase. In the UK it was 28.5 yrs in 2000, 29.4 yrs in 2009 and 29.5yrs in 2010.

The Office for National Statistics states that from 1990 to 2010, the number of live births to mothers over 40 has trebled.

If you practice ‘ecological breastfeeding’ and follow all the Department of Health and World Health Organisation recommendations, the average time for the return of a woman’s periods is 14.6 months. Many women don’t feel that they have that long to wait.

If we are supporting a woman who wishes to fall pregnant, one message is that abrupt changes in breastfeeding patterns are more likely to provoke hormonal changes and cycle changes than gradual slow ones. But what else might it risk? Blocked ducts and mastitis? Or distress for a nursling? Mothers are having to make decisions that feel difficult.

The later a woman’s cycles return, the more likely that ovulation will occur before the first period. When periods return earlier, the early cycle is often infertile and a woman may not achieve luteal competence.

There is a massive range of normal. But I think it’s important to be honest as breastfeeding advocates and state that for some women, continuing to breastfeed may be compromising their fertility. There are those of us who fall pregnant easily while breastfeeding but we must not pretend this is going to be everyone’s story.

Some breastfeeding women are considering whether to undergo IVF or fertility treatment. Many clinics will ‘require’ women to stop breastfeeding. And some women will simply mislead clinics and claim they no longer breastfeed when they do. Some fertility drugs have not been studied sufficiently to ascertain their safety while breastfeeding. Clomid is commonly used but has also been used elsewhere to suppress lactation and has been connected to a reduction of serum prolactin.

Older women and women with a history of fertility problems are likely to be those mothers with a particular commitment to breastfeeding. The dilemma of whether to prioritize breastfeeding or conception can be a painful and difficult one.