Whose Milk? Changing US Attitudes toward Maternal Breastfeeding

In the spring of 2018, government delegates from around the world gathered in Geneva, Switzerland for the World Health Assembly in affiliation with the United Nations. Delegates from Ecuador introduced a resolution, outlining a policy supporting maternal breastfeeding and calling for better regulation of the marketing of breastmilk substitutes. Most delegates expected the resolution to pass without much deliberation. Delegates from the United States, however, had other plans and stymied the resolution by calling for the removal of language that urged governments to “protect, promote, and support breastfeeding” and to reduce the promotion of breastmilk substitutes.

The deliberations over breastfeeding that erupted in Geneva highlighted not only the conflicting commercial and health interests of nations like the United States and Ecuador, but also the ongoing international concerns around better infant-feeding options for working mothers and the corporate promotion of food products detrimental to infant nutrition. Trump Administration officials cited that the proposed resolution unnecessarily stigmatized women who are unable to breastfeed and hindered mothers from accessing formula.

While the language of the resolution did not go so far as to deny access to milk substitutes, it supported efforts like the Baby-Friendly Hospital Initiative, which seeks to provide mothers with the necessary tools and information to breastfeed their infants and to promote the safe use of formula, especially in low-income settings. The US is currently one of the top three high-income countries (alongside France and Ireland) that reports the lowest rates of maternal breastfeeding.

Yet shifting attitudes toward maternal breastfeeding are nothing new to American society. In fact, the eighteenth century witnessed significant transitions in both medical advice and maternal practices surrounding breastfeeding. Well into the late eighteenth century, middle- and upper-class white women in America exhibited low rates of maternal breastfeeding. Ideas about fashionability and status dictated cultural norms, leading many women of means to employ wet nurses. At the same time, lower-class women had little choice but to breastfeed their own infants, while enslaved black women were forced to nurse their owners’ infants.¹

Women’s access to information also shaped their attitudes towards and practices of maternal breastfeeding. For example, literate mothers were more likely to read advice books on maternity and put their recommendations into practice.

The most widespread belief among both physicians and mothers in the seventeenth and eighteenth centuries was the taboo against administering colostrum, or first milk, to newborns. Seventeenth-century midwifery books and medical advice published in Britain and sold in the American colonies deemed colostrum to be toxic to infants, and thus many mothers postponed neonatal breastfeeding. In 1671, for example, English midwife Jane Sharp wrote, “It is not good for a woman presently to suckle her child because those unclean purgations cannot make good milk, the first milk is naught.”²

But depriving infants of colostrum left them without much-needed antibodies, delayed or impaired mother-child bonding and infant development, and caused breast maladies that left mothers unable to nurse. New mothers often relied on wet nurses during the initial two or three weeks postpartum while her milk came in. Family friends also volunteered to nurse newborns if a family could not afford to employ a wet nurse.³ As the eighteenth century progressed, doctors eventually began to retract their former advice regarding the perceived dangers of colostrum.

There were, of course, other factors that prevented mothers from suckling their own infants and led to the employment of wet nurses: disease, insufficient milk supply, breast infections or abscesses, fatigue and stress, and even maternal mortality. Thus, families may have had little choice but to resort to wet-nursing or dry-feeding by bottle to ensure their child’s survival.⁴

Even so, concerned parents selected their wet nurses carefully. Early-modern individuals believed that wet nurses could transmit temperament to an infant via breastfeeding. Families avoided wet nurses who exhibited perceived physical or psychological “extremes” in hair color, skin complexion, or temperament. Communities even preferred the sex of a wet nurse’s own child to match that of the suckled infant due to fears over the transmission of effeminate traits to male infants or masculine ones to newborn girls. While family and friends gave advice on the matter, it was ultimately a husband’s responsibility to select and employ the wet nurse.⁵

In April 1771, for example, Samuel Johnston deliberated over the state of his wife and newborn daughter’s health. The lawyer from Edenton, North Carolina weighed the possibilities of alternative nursing after a difficult first pregnancy. Should Frances Johnston, his young wife, jeopardize her health by continuing to breastfeed? Should they try a bottle or employ a wet nurse? The Johnstons must have at least considered engaging a wet nurse — an enslaved black woman — as a letter from Samuel’s cousin indicates:

[gblockquote]I really think Mrs Johnston Is in the Right [to nurse her own infant] It is really a very Extraordinary care & but Very Seldom happens that a mother is not able to Suckile her Child and I am amazed to the last degree when people of sence & Humanity prefer a Black (or any other) Nurse than those God had Provided.⁶[/gblockquote]

Given the popular beliefs surrounding transmission of traits through breastfeeding, visitors to southern homes often remarked upon the “strange” practice of using enslaved black women as wet nurses for white children. Historians, however, are divided on how representative the use of enslaved wet nurses was among the planter class. “Wet-nursing,” historians Emily West and R. J. Knight argue, “conveys ways that white women manipulated enslaved women’s motherhood for their own purposes.”⁷ Historian Catherine Clinton has argued that in the US, white women breastfed their own children in the eighteenth century, and only began employing wet nurses in the nineteenth century.⁸

In North Carolina, it seems that women of the planter class preferred to breastfeed their own children, but they were not averse to wet nurses when they encountered problems on their own.⁹ Historian Sally McMillen writes that most mothers in the antebellum South were glad to have an enslaved wet nurse to help ensure the survival of their infant. At least by the nineteenth century, “available milk, not race, was the criterion.”¹⁰

In many ways, the practice mirrored that of the English upper class in the early eighteenth century.¹¹ And the commodification of enslaved black women’s reproductive lives was not a specifically American phenomenon. Enslaved wet nurses appeared in various Atlantic locales, including Brazil and the French colonies.

Late eighteenth-century advice manuals, written by both male physicians and female midwives, promoted maternal breastfeeding, contributed to a new sentimental ideal of motherhood, and shaped ideas about white, middle-class womanhood well into the nineteenth century. “To be a woman was to be a mother, and to be a good mother was to fulfill the highest and most sacred purpose of womanhood,” writes historian Nora Doyle.¹²

This coincided with shifting cultural attitudes that associated breastfeeding with maternal pleasure and emotional satisfaction that writers often described in sensual, if not overtly sexual, terms. American midwife Mary Watkins declared in 1809 that mothers who did not breastfeed their children were “deprived of a very high source of pleasure, of the most tender and endearing kind.”¹³

Cultural norms, socioeconomic background, maternal health, and other factors have long shaped the practice of breastfeeding and the experience of motherhood in the US. Similar concerns that plagued early modern families still do so today. Access to milk alternatives can be vital to infants whose mothers are unable to nurse, as is access to information about best practices. The debate over maternal breastfeeding at the World Health Assembly highlights the very political nature of cultural norms surrounding women’s bodies and motherhood, which have been evident since the early-modern era.

Kimberly B. Sherman

Kimberly B. Sherman received her Ph.D. in Modern History at the University of St. Andrews. Her work examines Scottish family networks in the early modern Atlantic and North Carolina. She is currently a lecturer in history at Cape Fear Community College in Wilmington, NC.

• Kimberly B. Sherman

  https://nursingclio.org/author/kimberly-b-sherman/

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