Is Breastfeeding Intuitive?

Yes, but only for the women who have been taught how to do it

There is a widespread assumption that breastfeeding is natural, intuitive, and even instinctual. After all, humans are mammals. No one had to teach the mama bear how to nurse her cubs. She just knew. Otherwise, how would they have survived all this time? If every mama bear needed a lactation consultant, that would have been the end of bears a long time ago.

The same logic ought to follow for humans. Breastfeeding was such a critical element of childcare throughout most of human history that nature could not afford to leave it to chance. It has to be hardwired. Right?

The definition of “intuitive” is: knowing or understanding something right away without needing to think, logic, or learn it. Similarly, the definition of “instinctual” is: based on, relating to, or happening as a result of instinct (defined as inherent aptitude) rather than through conscious thought, planning, or training.

So I could not help but laugh out loud when, while reading this excellent paper on breastfeeding practices among the Himba pastoralists, anthropologist Brooke Scelza found that 91% of Himba mothers agreed with the statement “Breastfeeding is instinctual, it doesn’t need to be learned,” but 86% also agreed with the statement “Women need to learn how to breastfeed properly.”

Brooke Scelza, a human behavioral ecologist and professor at the University of California Los Angeles, has spent years studying the Himba, a group of pastoralists living in a remote desert region of northern Namibia, close to the Angolan border. Known for their distinctive style, the women cover themselves with otjize paste, a mixture of butterfat and ochre pigment—reddish orange in color—which they rub over their bodies and in thick layers over their plaited hair. The men are herders and the women take care of chores in camp and look after young children. They eat a diet of sour milk and maize porridge, cornmeal, chicken eggs, wild herbs and honey, and occasionally meat from their livestock. The women, although they often go to live with their husband’s family after marriage, maintain close ties with maternal kin, and typically return to the camp of their female relatives to give birth and recover.

A Himba mother breastfeeds

Scelza was interested in understanding what kind of support these women got from their mothers and female relatives with breastfeeding, and whether this assistance made a difference in their success. What she uncovered was this surprising paradox: breastfeeding is instinctual, but you have to learn how.

Although the contradiction made me laugh, it was more a laugh of recognition than of condescension. You see, I think the Himba are right. Breastfeeding is, in many ways, instinctual. The urge to feed your baby when it cries feels very instinctual. The way seeing your baby, smelling your baby, or even just thinking about your baby can trigger a milk let-down feels very automatic—clearly not the domain of reason. Allowing your baby to suckle on demand, until they are full and turn their head away, feels natural and rather obvious.

And yet, there are so many things about breastfeeding that don’t feel natural at all! How are you supposed to hold the baby while you offer the breast? What’s the optimal position? What do you do if you get a clogged duct? What do you do if you you have nipple pain? How do you get a decent night’s sleep?

Himba mothers, apparently, receive instruction on all of the above, mostly from close female kin, primarily their own mothers. In the study, 73% of mothers named their own mother as their key breastfeeding helper/teacher, 20% named other maternal kin, and 6% named paternal kin. Himba women typically return to their natal home before giving birth and stay there for weeks to months postpartum, specifically so this kind of intensive, hands-on teaching can happen. The key helper doesn’t just give advice from a distance; she sleeps in the same hut, provides round-the-clock support, and takes over cooking, washing, and other household tasks so the new mother’s main job is recovering and learning to feed.

Himba grandmothers teach their daughters things like how to get the nipple properly into the baby’s mouth, how to clean the breast before feeding, how to handle and position the baby, the importance of responding promptly when the baby cries, and how to co-sleep safely with the baby. One common recollection from Himba mothers was that in the early weeks after a birth, Himba grandmothers, who would sleep in the hut with their daughters and the infant, would wake them at night and tell them to feed their babies.

These grandmothers provided not just practical advice but also emotional support. According to the Himba, breastfeeding difficulties, like pain, loneliness, and fear are simply part of the process. They are to be expected. Pain while feeding, for the Himba, does not necessarily mean you are doing it wrong. As one breastfeeding mother said, “My mother told me, ‘…that’s the war of the woman, that breastfeeding pain’.” Another mother told her daughter, “it’s painful because it’s the first time. Just keep going and it will get better.”

As might be expected, it was first-time mothers who reported the most breastfeeding difficulties, with more than half agreeing that it is difficult to breastfeed a first child (for women who had already had three or more children, on the other hand, almost every single one said breastfeeding was easy). These new mothers were the ones that most needed help, lending support to the idea that breastfeeding (for humans, at least) is a skill that takes practice and instruction.

In short, the expectation among the Himba seems to be that you “just know” how to breastfeed because you are surrounded by a support system who will guide you through the process. It’s instinctual, but it takes practice; intuitive, but learned; lonely, but social.

What does this mean for mothers today?

Breastfeeding as a social experience

I learned how to breastfeed by reading a 352-page book called Breastfeeding Made Simple. I like to joke that, if it were indeed so simple, we would not need 352 pages to explain it. Learning to breastfeed by reading is a bit like trying to assemble Ikea furniture by reading the wordless two-dimensional instructions that come in the box. It would be a whole lot faster if someone could just show you, in the real world, how to do it, but alas, they don’t send human teachers with the delivery.

Throughout most of human history, we didn’t need books, because breastfeeding knowledge was passed down intergenerationally, from woman to woman, through a combination of direct observation, practice, and in-person assistance. Before the advent of birth control and infant formula, most women spent most of their adult lives breastfeeding. A woman typically had her first baby at around the age of twenty and her last around forty, and in between births she was constantly breastfeeding. As biological anthropologist Wenda Trevathan writes in her book Ancient Bodies, Modern Lives, “because most of their reproductive years were spent pregnant or breastfeeding, ancestral women may have had only 100-150 menstrual cycles in their lives,” compared with a modern woman who may have as many as 400.

One consequence of this was that a girl growing up in a nomadic foraging society could not help but witness lots and lots of breastfeeding. Nearly every adult woman—her own mother, aunts, cousins, friends—would have been constantly breastfeeding, and in a very public way. Because infant feeding is such an integral part of daily life for these women, covering up or hiding breasts would have been incredibly impractical, and so it was simply not done. Except in very cold arctic climates, I have never seen a hunter-gatherer society in which the women systematically cover their breasts. In general, they are topless, and more often than not, there is a baby at the breast, suckling.

In many hunter-gatherer societies, girls are given simple dolls made from natural materials, or they make dolls from things they find, and they often play at mother and father with their little boyfriends, making fires, building little huts, and caring for their dolls. The girls have been observed to practice putting the dolls to the breast, imitating what they see their mothers and female relatives doing. As one Aka hunter-gatherer woman recalls in Bonnie Hewlett’s book, Listen, Here is a Story, “Sometimes I would build a little hut close to my parents and play with my friends, and we would pretend we were married. I would take a piece of wood and pretend I was a mother, and I nursed my baby.” In other words, the training and preparation for breastfeeding begins very early, and is partially learned through play.

We know, from studies of primates in captivity, that when females are deprived of opportunities to witness other mothers breastfeeding, they struggle to feed their own infants. Primate mothers raised in isolation are typically unable to nurse at all, and ape mothers who have had the opportunity to watch other mothers nursing are more successful at feeding their own infants (source). In humans, breastfeeding is thought to be more complex than for other apes, because of the shape and size of our breasts and how immature our babies are born (which makes it harder for them to latch and suck). As a result, many researchers believe that intergenerational social learning has always been a key element of breastfeeding success for human mothers.

In our culture today, not only are we deprived of this transmission of hands-on intergenerational knowledge and support, but we are often left alone to manage a home, care for older children, and resume full-time work within weeks of giving birth. Perhaps partly because of this, only about half of women in the US actually meet their own breastfeeding goals (source). As societies industrialized around the world, and mothers increasingly found themselves far from their own maternal kin, and the sexualization of breasts changed cultural norms around toplessness and public breastfeeding, opportunities for peer learning and direct observation, in-home assistance from older women, and intergenerational cultural knowledge slowly dried up.

From lateral feminine wisdom to top-down male expertise

I have already written extensively about the history of the “expertization” of motherhood, so I won’t bore you with the same story all over again. But, in short, some time around the 1930s, the scientific and medical establishment began to realize that breastfeeding was still nutritionally superior to infant formula, and that breastfed infants had markedly lower mortality rates. But by then, women had already lost the war. Infant feeding was now the domain of science, medicine, and “experts,” who did not value the intergenerational wisdom and hands-on expertise of mothers.

It’s hard to point to one precise moment at which this happened. As I wrote about here, the first infant formula was invented by a man named Justus von Liebig in 1865. The formula itself was a failure. Every infant it was tested on died. But Liebig, who is considered one of the founders of organic chemistry, embodied scientific advancement. People were beginning to believe that almost any natural substance could be broken down to its component parts, and then rebuilt, better, by man.

Later, when pediatricians realized we had jumped the gun, they did not turn around and apologize to women, or validate the wise old grandmothers who had been shaking their heads all along. Instead, they shifted their focus from pushing modern and “scientifically superior” infant formula to dictating scientifically managed breastfeeding strategies. Mothers were strongly discouraged from feeding “on demand,” and instead taught to stick to a strict schedule, with long intervals between feeds.

This created a lot of internal conflict for mothers, who felt intuitively driven to respond to their babies’ cries for food. Historical accounts from the 1930s and 40s document how immigrants to the US, who grew up in cultures where breastfeeding knowledge was passed down from woman to woman, suddenly felt themselves caught between the advice of American pediatricians and the advice of their own mothers. One woman recalled how her physician insisted that the baby be fed on a strict schedule, and if she awoke before the next feeding time, to ignore her. This advice rightly horrified her own mother, the grandmother, but the woman felt compelled to follow the pediatrician’s advice. “If [the doctors] said every four hours, every four hours. It was the right thing to do,” she said. (source).

Historian Rima Apple writes that “gender is a fundamental component to understanding this transition in scientific motherhood. The experts were most frequently depicted as male, usually physicians; science, medicine, and professionalism in general were described in male terms,” whereas the intergenerational wisdom of women was dismissed as “unscientific.”

And we are still living with this legacy today. I cannot tell you how many women have reached out to me over the years to say that they were relieved to learn that on-demand feeding was the norm throughout most of human history, because they had been taught by doctors, nurses, or relatives that they should follow a breastfeeding schedule and ignore their babies cues.

Clearly, there is such a thing as bad breastfeeding advice.

Why we still need breastfeeding support

What I find ironic about the whole story is that we seem to be coming full circle, back to where we started, only this time, it’s scientifically validated. It seems the Himba grandmothers were right about most things all along, but it took 100 years of scientific iteration to realize that breastfeeding frequently, on demand is indeed the right approach, that co-sleeping supports breastfeeding success, and that, although many aspects of breastfeeding are intuitive, most moms still need help trouble-shooting problems, especially first-timers.

This study, by another of my favorite anthropologists, Abigail Page of Brunel University of London, found that only 6.5% of the 565 UK mothers in the sample reported zero breastfeeding problems! Most experienced 2-3 issues, and about a third experienced 4-8 separate problems. Sore/cracked/blistered nipples and thrush were the most common (71%), followed by latching difficulties (56%).

Interestingly, they found that not all problems predicted early cessation of breastfeeding equally. Latching problems and "not enough milk” were strongly associated with increased likelihood of stopping (3.1x and 2.3x higher weekly hazard, respectively), whereas too much milk, blocked ducts, and sore nipples were actually associated with reduced likelihood of stopping. Tongue-tie, shockingly, had no significant effect.

The authors’ interpretation is that problems tied to the infant’s nutrition (latch, low supply) get treated as legitimate, guilt-free reasons to stop, while problems that are just the mother’s pain/inconvenience (sore nipples, blocked ducts) get pushed through. Mothers are tough stuff, but when the baby’s health or growth is on the line, the balance tips. Sadly, as I wrote about here, many studies indicate that it’s “perceived insufficiency” rather than actual breastmilk insufficiency that is the number one reason why women stop breastfeeding.

But back to the question of social support. Page and colleagues found that social support does indeed “buffer” against breastfeeding cessation, but only when that support is actually rated as helpful. For blocked ducts, too much milk, and sore nipples, helpful informational, practical, and emotional support consistently lowered the hazard of stopping, while unhelpful support (from partners, midwives, GPs, friends) raised it, sometimes dramatically.

Go figure. Women need support, but they need the right kind of support; support that is actually helpful. They need the support of an experienced Himba grandmother, not an overbearing mother-in-law who can’t understand why they don’t just switch to formula already.

I don’t mean to suggest that continuing breastfeeding is always the right decision in every case. I have written extensively about the health benefits of breastfeeding for both mothers and babies, but I am also the first to say that if trying to breastfeed is ruining your life, or your relationship with your baby, then go ahead and stop! In fact, Page’s research suggests that one of the benefits of social support is helping mothers deal with the guilt of stopping earlier than planned when they need to. A truly helpful supporter will also recognize when stopping is the right choice.

Perhaps most interesting of all, Page and colleagues found that informational support from partners, sisters, and friends mattered at least as much as advice from professionals, which brings us back to square one. Breastfeeding is indeed intuitive, but breastfeeding mothers need help and social support. For millions of years, that support came from real people in our immediate community; from other women who had spent many years perfecting the art. Just like every other aspect of parenting, this is not something our species evolved to do alone. But it’s not something we were meant to learn in the doctor’s office either.