Book Review: Nighttime Breastfeeding: An American Cultural Dilemma

Nighttime Breastfeeding: An American Cultural Dilemma. Cecilia Tomori, New York: Berghahn, 2015, 299 pp.

Tomori’s title focuses our attention on a seemingly mundane practice, nighttime breastfeeding, that plunges middle-class U.S. parents into a minefield of contradictory cultural expectations and values. New parents, mothers in particular, are urged to breastfeed their children to secure potential health and developmental benefits, but circumstances that support successful breastfeeding, such as co-sleeping and breastfeeding itself, are discouraged and even stigmatized as actual practices. To demonstrate how these contradictions are embodied and negotiated by new parents, Tomori draws on ethnographic interviews and participant observation with 18 couples, all middle class and predominately heterosexual, married, and white. She also interviewed health care practitioners, childbirth educators, midwives, and others. In so doing, she captures mainstream ideologies of U.S. culture in relation to the political economy and institutional frameworks in which they are embedded. Capitalist labor regimes and market strategies, biomedical institutions and health care delivery, and concepts of personhood, kinship, and family all contribute to the dilemmas faced by mothers and their partners as they try to enact “good” parenting through breastfeeding.

This work participates in the anthropological discussion of women’s reproductive role as embodied practice. It situates this discussion in the context of cross-cultural and feminist work on the subject. By focusing on historical and contemporary U.S. attitudes toward breastfeeding and co-sleeping, the extent to which negative attitudes toward breastfeeding and co-sleeping are at odds with most of human history and prehistory around the world is under- emphasized. Likewise, common solutions found in other cultures, such as multi- generational households and residing with or nearby kin and supportive others— strategies temporarily used by Tomori’s informants—are not linked to this broader context. By contrast, Tomori vividly describes a world of breast-pumps and freezers, eight-hour workdays predicated on six–eight hours of uninterrupted sleep, and babies who sleep in their own beds for long periods of time. These conditions impinge on the physiological, mental, and emotional attunement of mothers and babies in an ongoing breastfeeding relationship.

Tomori identifies many obstacles to her informants’ commitment to breastfeeding. One might well see the complex challenges they face as an extreme test of mothers’ and babies’ ability to adapt to unfriendly social demands and conditions. She argues convincingly that a relational view of breastfeeding, rather than the materialist and health-related one that currently prevails, would provide a more supportive cultural environment for successful breastfeeding and bonding for mother, child, and father/partner.

Tomori begins by examining sources of expertise and advice on the subject of breastfeeding and co-sleeping. Historically, this domain of knowledge in U.S. culture has been wrested from women in extended kin relationships and taken over by the biomedical establishment. During the height of modernity, post WWII, breastfeeding and co-sleeping became associated with poverty and backwardness and was supplanted by the “clean” and orderly regimen of scheduled bottle-feeding and solitary sleeping, thought to help socialize babies to become independent, self-actualizing individuals. Now revalued mainly for health reasons, breastfeeding is seen as a moral responsibility of mothers, but a cultural infra-structure of intergenerational knowledge is mostly lacking. Into the breach has come biomedicine as a highly valued knowledge system, but it is one in which expertise often is disconnected from daily experience. In addition, cultural nervousness over the sexual overtones of bed sharing and nighttime feeding creates an atmosphere of suspicion and danger that prevents new mothers and fathers from sharing their concerns and challenges with health care professionals, kin, colleagues, and friends.

Tomori examines these dilemmas through a series of lenses. She explores the knowledge offered and acquired through different kinds of childbirth education, noting that this construction of expertise privileges those who can seek out and afford to pay for these services, mainly working people with health insurance benefits and time to engage in classes. The “naturalized” activity of breastfeeding has to be learned, but expert advice typically emphasizes the technique of latching on and metrics of supply and demand, disconnected from the challenges of sleeping (or not sleeping). The support for breastfeeding offered in hospital contexts is often subverted by producers of infant formula who promote the convenience and reliability of their product. Breastfeeding thus becomes a privileged practice for those who can afford it— especially since it entails uncertainty, a major time commitment, and a reorganization of household labor, work, and sleep.

The typical assumption by parents-to-be is that their baby will sleep separately, and preparations are made on this basis; but successful breastfeeding is best accomplished through on-demand nursing, including at night. For the most part, new parents are on their own to find a workable solution, and Tomori documents their ongoing efforts to balance the demands of domestic and paid work, their changing relationship as a couple, and the best interests of their baby. Their adjustments reveal the inadequacies of parental leave, child care, support networks, and surprisingly widespread attitudes toward breastfeeding and co- sleeping as unreliable, unclean, and potentially immoral. Tomori refers to these conditions as the “moral minefield” of breastfeeding, in which the mother’s body may be viewed as an inadequate and unreliable “machine” that does not provide enough or good enough food for her baby. Parents who practice and even enjoy co-sleeping and bed sharing for part or all of the night resort to concealing a practice that on closer examination appears to be more normal than not. One informant, a nurse, admitted to feeling somewhat guilty about advising parents never to sleep with their babies—who are to sleep only on their back alone in a secure crib—and going home to nurse and sleep with her own baby.

A widespread practice of co-sleeping has become covert, in the face of statistics and biomedical advice about SIDS and SUIDS. Cultural resistance to co-sleeping and bed sharing has not been successfully challenged using advice and evidence to the contrary from cross-cultural comparison or reanalysis of it in U.S. culture and evidence of its benefits. Those of Tomori’s informants who enjoy the closeness that co-sleeping promotes and resist pressure to train their child to sleep separately are also prompted by the experience to re-frame prevalent views of child development, secure attachment, and what promotes eventual autonomy in children.

Some feminist arguments, examined at various points in Tomori’s discussion, critique breastfeeding as promoting patriarchal family structures by confining women to a dependent, domestic role. Tomori’s informants, including one lesbian family, reconfigured their work/home routines to enable breastfeeding day and night. The men/partners became protectors of the breastfeeding relationship vis-à-vis kin and community, and in many instances took on more domestic labor to mitigate the lack of cultural and structural support for breastfeeding. Nevertheless, necessary flexibility often came from having one parent as the primary income earner, while the second was able to get by for a time in secondary labor conditions, such as being a student, working part time, working from home, and so on.

Tomori draws on Bachelard’s (1994 [1958]) analysis of the middle-class household as the site of reproduction in a system of labor, property, and social class relations. She examines the moral order expressed in physical arrangements of her informant families’ households, especially the separate baby’s room and parents’ bedroom. These are the primary spaces in which each couple adjusted to the need for physical proximity of mother and child throughout the night. Parents wrestled with the cultural script that co-sleeping and prolonged breastfeeding might lead to a “spoiled” and “demanding” child, rather than the secure and independent child they hoped to raise. The dominant cultural models must be and are re-worked, household by household, but only for a time. Perhaps, like daycare and parental leave, cultural expectations and accepted practices are slow to change because each family works through them for a period of time only, then moves on as their children grow up.

Tomori is meticulous in describing her own role in this work and her care in protecting the anonymity and privacy of her informants. She situates her work as part of a broader project that needs to be undertaken to understand how these cultural models and scripts play out for different sectors of the U.S. population— by race, class, gender, and ethnicity. This work will be useful for medical anthropologists and professionals at all levels of reproductive health care and family medicine. It offers important ethnographic analysis relevant to feminist anthropology, women’s and gender studies, and cross-cultural and bio- evolutionary perspectives on kinship and family.

Reference Cited

Bachelard, G.
1994 [1958] The Poetics of Space. Boston: Beacon Press.

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