'Like a piranha': how midwives' descriptions of breastfeeding affect women's attitudes

The World Health Organisation (WHO) promotes exclusive breastfeeding as the optimal way to feed infants. Most Australian babies – 96% – start out breastfeeding. But this figure drops to 61% exclusive breastfeeding at one month, 39% at three months and a very low 15% at five months.

The reasons women stop breastfeeding are widespread. They include pain and discomfort during early establishment, lack of support, fear the baby is not getting enough milk, plans to return to work, and worry about the baby’s enjoyment or fulfilment.

A woman’s confidence with breastfeeding can be impacted by her baby’s behaviour and the perceived quality and quantity of milk. Mothers often look to health professionals in the first few days after birth for help in making these assessments.

But a study my colleagues and I conducted in New South Wales found that the sometimes negative language that health professionals use, when describing normal behaviour while feeding, is far from helpful.

If health professionals' interpretations of baby’s behaviours are negative, a woman may question whether breastfeeding is meeting her baby’s needs. The language used to describe the baby matters. Women who are not enjoying breastfeeding, or think their baby is not enjoying breastfeeding, are more likely to wean early.

Blaming the baby

Published in the journal Maternal and Child Nutrition, our research observed the breastfeeding interactions between 77 women and 36 midwives or lactation consultants at two New South Wales hospitals in the first week after the women gave birth. We also interviewed some of the midwives and the women separately.

At times health professionals attempted to shift blame for breastfeeding difficulties away from the mother. But in so doing they inadvertently placed blame onto the baby.

Midwives used terms such as “impatient” and “lazy” to describe the infant. Babies were deemed impatient, for example, if they were crying at the breast and not sucking. This was attributed to inheriting an “impatient personality”, demonstrated when the milk was not flowing fast enough for them at their first sucking efforts.

Some babies were considered “lazy” if they were not sucking for long enough or not acquiring sufficient breastmilk at each breastfeed.

In the first week after birth, health professionals took on the role of “infant interpreter” and offered what they thought the baby was “thinking”. The implication was that newborn babies had the capacity to think, make decisions and choose whether to cooperate with breastfeeding or not.

There was a definite impression that the baby had a “job” to do during breastfeeding. In this setting, a baby who “cooperated” with breastfeeding, and performed their “job” properly, was labelled “good”, “clever” and “smart”. Yet if the staff member felt the baby had “decided” not to “cooperate”, they used negative language.

Babies who were unsettled and “uncooperative” were described as being “cross”, “cranky” and “angry” during breastfeeding because the milk was not flowing fast enough for them. Babies were described as “complaining”, having “temper tantrums”, getting themselves into a “tizz” or using their mother as a “dummy”.

These kinds of repeated negative references to personality and unfavourable interpretations of baby behaviour ultimately influenced how some women perceived their babies.

The following quote demonstrates how the words health professionals use can become embedded in a woman’s own language. While this woman was in hospital, she told the midwife that she had sore nipples. The midwife replied:

Your nipples are a bit tender because you’re not used to having this little piranha hanging off them every five minutes.

Six weeks later, I interviewed the same woman at home and asked her to describe her early breastfeeding experience. She replied:

With the latching on and that, she’s a bit like a piranha. She grabs straight on…

Comparing the newborn baby to a harmful creature with a voracious appetite could have significant implications for the mother-baby breastfeeding relationship.

Mother and baby are both learning

We found that more positive language and interpretations of baby behaviour during breastfeeding emerged when health professionals viewed the mother and baby as two participants in a reciprocal relationship.

In these interactions, the baby was seen as an instinctual being who was learning how to breastfeed, and so was the mother.

The language that emerged normalised baby behaviours and reflected more positive interpretations. It also facilitated the mother “tuning in” to the needs of her baby.

At times when women themselves used negative language to describe their babies, the midwives focused on the relationship and encouraged a different interpretation. In one example, a mother interpreted her baby as “a stubborn little bugger” who “doesn’t make decisions real quick”.

The midwife shifted the focus to a more positive reading of the baby: “he just may not be quite ready yet” and “just do some skin-to-skin with him”.

When it comes to supporting women to breastfeed, language is very important. It can positively, or negatively, influence the developing relationship between mother and baby. Language should aim to enhance, rather than undermine, the mother-baby relationship and should facilitate the mother “tuning in” to her baby by identifying normal newborn behaviours.