The following article is presented by HBIC contributor Valerie Wiens. Valerie has been supporting breastfeeding families in China since 2008. She is a La Leche League leader and an International Board Certified Lactation Consultant (IBCLC).

In the Mix (Part 1)

The Laowai Father and Chinese Mother as New Parents

In my experience with supporting new families with breastfeeding, I occasionally come across a culturally mixed couple who have recently become new parents. They face a unique group of challenges. They are also blessed with a unique opportunity for growth and communication.

Usually, the foreign husband is the one who first contacts me. Though the laowai fathers are the ones who find me, the Chinese mothers are aware that he is contacting me and I make sure to talk with the mother directly. As I’ve helped several of these families, I have noticed some strong recurring themes. I hope I can bring a voice to these couples and share with you what they’ve shared with me so that you can avoid the common pitfalls. Since I am a Westerner I often share the father’s perspective but my clients are almost exclusively Chinese mothers so I understand their perspective as well.

I can think of no better way to explain the issues than to share an email I received from a new foreign father last year. Underlined are the crucial issues that are likely to plague mixed couples:

“My wife and I have a two-week baby born via c-section who has been fed formula the first three days at the hospital, and since coming back to the house breastfeeds very slowly, preferring to snack at the breast and chow down on the bottle.  He also falls asleep at the breast every five minutes or so, and if breastfed fully takes two to three hours of constant engagement to be full (this has only happened a few times; most of the time my wife is too exhausted to continue and we have to top him off with formula).  Our day-only yuesao prefers to have him sleep during the day (feeds him formula and water when he cries, or quiets his cries with songs and loud voices until he submits and calms down).  Our son is usually far more hungry at night, often releasing the full facility of his vocal cords (which are quite impressive), which is troubling my wife because she doesn’t have the energy to stay up after trying to nurse him during the day, and she has slowly been sinking into further postpartum depression as the baby continues to get full off formula and refuses to really take her milk as a main food source, preferring to fall asleep at the breast rather than eat.

My wife wants to exclusively breastfeed.  Right now as we are living at the parents home, that seems to be an impossibility with the yuesao’s feeding methods and the fact we didn’t hire her (my mother-in-law did) so to cause any issues would cause a major breach of face in the home.  We will return to our home in about three weeks, at which point we hope to transfer our son from formula to Mommy.  We’d like to attend some of the Le Leche meetings and become members if my wife can handle the long trip, but I wanted to talk to you first to let you know our situation and ask if you had any advice and if exclusively breastfeeding after this very stressful month would even be possible.”

This email says it all. This new father lays out clearly all the major themes I see with most foreign/Chinese couples trying to breastfeed.

Let’s go piece by piece. Since there’s a lot of information here, we’ll split it up into two separate posts. (Click here to view Part 2.)

1. “born via C-section” 

According to the World Health Organization, China has the world’s worst C-section rates. Source. Many, probably most, C-sections are unnecessary. Starting in the hospital we see the cultural theme that will run through all the challenges this couple faces. The theme is, “The authority/expert knows best.”

I recently had the privilege of hearing Dianne Weisinger,  a world renown breastfeeding expert, speak; one thing she said is that anyone who has ever been around animals giving birth knows that there is really only one rule. “Stay out of the way. Don’t disturb the process unless absolutely necessary!” A birthing dog, cat, horse, or any mammal you can think of will have a difficult and stressful labor if she is disturbed and will be unable to bond instinctually with her babies after the birth. There is a sequence of instinctual behavior in human mothers as well. It is essential to getting breastfeeding off to a good start. But it is almost never allowed to play out in hospitals as the staff tend to feel a need to control the process. New mothers often welcome the unnecessary interventions trusting the hospital staff over their own instincts. Even if that means an unnecessary major surgery. Here’s an article from Dianne Weisinger, entitled, “What Your Baby Expects” translated into Chinese: 你的宝宝出生后期待些什么?.

C-sections not only interrupt the natural sequence that would lead to healthy maternal-infant bonding, they make breastfeeding more difficult. After a C-section, a mother is encouraged to lay on her back and not move to recover. It’s hard to hold the baby and find a comfortable breastfeeding position. Ideally, new mothers would have almost constant skin-to-skin contact with their newborns. In China, mothers who deliver naturally rarely manage to exclusively breastfeed in the hospital.  C-section mothers are even less likely to be able to. This is not a biological problem. The good news is once the placenta is delivered – even by C-section – the normal sequence of milk production starts. With knowledge and support a mother can breastfeed after a C-section: http://www.muruhui.org/mrxx_detail.asp?id=507

2. “fed formula the first three days at the hospital” 

The World Health Organization explicitly says that babies should not be given any supplements (including water and formula) unless medically indicated and should be exclusively breastfed for the first 6 months. Source. All the real experts agree that supplementation is rarely necessary, though breastfeeding education and support is often necessary. Still, feeding a baby formula in the hospital is normal in China. So normal that parents who don’t do it will likely receive criticism and pressure.

See this link for a list of reasons why early supplementation is harmful:

English | 中文 (Coming Soon)

Family pressure is another reason Chinese mothers don’t breastfeed until discharge. Family members tell them they “don’t have milk.” There is little understanding of colostrum. See this link to learn about colostrum: English and 中文

There is another Chinese culture piece here. Perhaps because of times of poverty and famine the nation has faced in the past, especially the older generation equates feeding someone with love. As such, over-feeding is giving your child lots of love! The Chinese grandmothers I have observed and worked with think that a peep from a baby is an expression of hunger and they are quick to take matters into their own hands (bottles) if they decide that the mother’s breasts have not satisfied the baby. Certainly, we must understand that this behavior is an expression of love and a statement of the baby’s value. Unfortunately, it not only undermines the milk production system, but also the new mother’s fragile confidence. (It also introduces pathogens into the infant gut, stretches it so they need more formula, compromises it’s defense systems and has been solidly linked to increased risk of allergies and infection.) Source.

Again we see the theme heralded by both hospital staff and family members, “a new mother has no experience, so how can she be trusted to care for this baby? We know ‘breast is best’, but we can’t even make sure she’s doing it right because we can’t see how many milliliters are going into this baby!”

3. “preferring to snack at the breast and chow down on the bottle”

I like the way this father puts it! It certainly does appear that a baby “chows down” on a bottle. The reason for this impression is that the baby cannot control the flow of milk and is forced to take it all and take it fast. A bottle is less work for a baby but the fast flow is more stressful. Breastfeeding develops oral facial muscles that have been proven to have lifelong benefits. Source. After not being able to practice for the first three days, a baby may not really know what to do at the breast and become frustrated with the slower flow of milk.

The mother’s milk supply may also be compromised at this point. You see, breastfeeding is a supply and demand system. Having no demand for some time, the biological reaction is to slow down milk production. This is how milk production works: English.

4. if breastfed fully takes two to three hours

The mother is understandably tired, but the baby is staying at the breast to tell her breasts what he needs. Remember, the breasts are responding to demand and the milk-order is being sent to the bottle instead of the breast. So the breasts are confused and don’t know how much milk to make. If the supply and demand system had not been undermined, this kind of tiring pattern wouldn’t exist. If the mother wishes to increase her milk again, breastfeeding will look like this until her milk production has caught up to baby’s demand. Each time she allows her baby to stay at the breast for as long as he needs, she is actually fixing the problem and it will likely be easier very soon.

How to increase milk supply – 中文: 对乳汁分泌量的担忧.

“my wife is too exhausted to continue and we have to top him off with formula.”

They are giving formula to fix the problem of low milk supply but are in fact creating a low milk supply problem. A very common negative cycle.

The family feels helpless as they can do nothing but watch a new mother try to figure things out. But that’s how it should be! Mothers and babies learn by having the freedom to breastfeed often and follow their instincts. Babies cry for many reasons. For newborns, almost all needs and wants can be met at the breast. This translates into a lot of breastfeeding in the beginning. But if the family sees that the baby has to be at the breast often and they compare it with the bottle feeding pattern of: 5 minutes to finish a bottle, sleep for 3 hours, they will no doubt decide that breastfeeding is not enough.

To continue on to the second and final post in this series, click here.

Valerie

Valerie has been supporting breastfeeding families in China since 2008. She is a La Leche League leader and an International Board Certified Lactation Consultant (IBCLC). She is a contributor to the Having a Baby in China expert blog.