BREASTFEEDING .sx THE MOST NATURAL FUNCTION .sx Francesca Entwistle looks at some of the psychosocial and cultural issues surrounding breastfeeding .sx In a second article , we investigate ways in which milk production can be suppressed if a woman is unable , or does not wish , to breastfeed .sx IN this technological age , there is a tendency for people to forget that humans are mammals , just like zebras and gorillas .sx Suckling is the prerogative of all mammalian young , and the milk produced by the individual species is precisely adapted to their growth needs .sx Breastfeeding is a very emotive subject and the mere mention of the word can evoke strong responses , particularly from women .sx These are often influenced by very deep and complex sociological , cultural , psychological and psycho-sexual issues .sx Whether you were breastfed yourself , or whether you breastfeed your own child , depends on many variables , including your social group and economic position .sx In some societies , poor , marginally nourished women breastfeed successfully , while other groups of privileged , well-nourished women fail .sx Within modern Western society , breasts are often perceived as sexual objects , yet their primary function of nurturing of the young receives much less attention .sx An American woman's description of her first impression of breasts illustrate this point :sx " The first idea I had that people did breastfeed was from looking at Catholic missionary magazines of African women nursing .sx .. I didn't see a white person's breasts until I saw a Playboy magazine at the age of twelve .sx " .sx There appears to be a fundamental prejudice in our attitudes to public breastfeeding .sx Television cameras turn their lens on hungry women who , during a famine , are keeping their babies alive with this precious fluid .sx As long as they are black and devastated it is all right to watch .sx But how often does one witness white women breastfeeding on television without its being received as offensive ?sx Within our society , if a woman's breasts are lactating , she often feels obliged to withdraw to feed her baby , because to suckle a baby in daily life is perceived as a disturbing sight by many people .sx However , those people who object may well pay to watch a woman expose her breasts in the form of a strip-a-gram for the sexual stimulation of friends or strangers .sx The 1990s are proving to be the age of the working mother who is actively encouraged to return to work .sx But often the very men - fathers , husbands - who discover the excellence of breastfeeding and recommend it wholeheartedly do nothing to provide facilities in the workplace and do little to advocate the financial benefits and flexible schedules which are essential for those mothers who must or choose to remain in the wage-earning world .sx Women may now be able to control their reproductive functions , but men still seem to control the way our society is run .sx Those women who do decide to work and breastfeed often find their loyalties and their emotions torn .sx Breastfeeding is not only a method of physical nurturing , it is a way of communicating with another human being and a way of loving .sx As a result , breastfeeding is never just a matter of technique or just a matter of filling a baby up with milk in the same way you fill up the tank of a car with petrol .sx Breastfeeding involves strong emotions and feelings .sx If the mother is not happy and relaxed in a conducive , comfortable environment , the process will fail .sx When the mother is tense and anxious the secretion of oxytocin and the subsequent flow of milk is restricted .sx The mother needs constant support and reassurance .sx It is not enough to say :sx " Breast is best , but we always have a good alternative available if you find it too difficult .sx " The midwife , friend or companion needs to believe that " breast is not only best " but " breast is possible .sx " .sx Palmer draws an amusing but pertinent analogy to the primigravid mother who is having problems breastfeeding in the hospital post - natal ward .sx Imagine , she says , a young man embarking on his first attempt at sexual intercourse .sx Ask him to set about his task in a strange environment , where there are 'experts' he has never met before , ready to tell him how it ought to be done .sx When he starts , a busy 'expert' tells him how to do it and inspects his body with a critical expression , prodding him and his equally inexperienced partner in an insensitive manner .sx By the bed is an artificial penis - 'just in case he can't manage it' .sx Is it any wonder he fails , just as the mother so often fails and gives up breastfeeding in those very early stages ?sx Breasts are not genitals , but they are certainly important , both erotically and reproductively .sx Of course , not all cultures attach erotic values to breasts .sx In some , the breasts are purely functional .sx In Western culture , however , they are considered as secondary sex characteristics and signify qualities of attractiveness and femininity in women .sx Many men find breasts highly arousing .sx Regardless of the size of the breasts , their internal structure varies little from one woman to another .sx The nipple has many nerve endings and is often a source of pleasurable sensations during lovemaking , masturbation or breastfeeding .sx Sexual arousal itself tends to make the nipples stand erect and therefore turn outward , and the suckling of a baby has the same effect .sx The secretion of oxytocin from the brain is stimulated through the nerves in the nipple area .sx Oxytocin is also involved in sexual arousal and orgasm , and milk may sometimes spurt from the breasts during lovemaking .sx Some women experience an erotic arousal or orgasmic reaction to breastfeeding itself and may find this difficult to cope with and be disturbed by it .sx A mother's attitude to the baby may be influenced by the physical and emotional feelings during suckling .sx Many women experience a loss of sexual desire and libido while breastfeeding .sx Bailey believes this may be because many of the women's sexual needs are being met by the baby .sx Breastfeeding influences relationships and sexuality in many different ways .sx It influences the woman's feelings about herself , her own body and her relationship with her partner .sx Breastfeeding will also affect the man's feelings .sx Male confidence should be enhanced by emphasising his role as a husband and father , but if too much is expected of him , and he may not reach the standards set , he might feel he has failed and feel alienated from his partner and baby .sx Some men may feel jealous that what was once 'their' domain is now shared .sx Couples must try to communicate their needs and try and find ways of remaining close to each other while the woman is breastfeeding even if , during that time , there is no intercourse .sx Scott describes the other side of breastfeeding .sx While her husband loved to watch her breastfeed and found her increased bust size very attractive , leaking breasts during arousal could not be prevented and were seen as something of a dampener !sx Some couples may find breast fluid attractive , but many people are affected by Victorian attitudes , where the only body fluid felt to be socially acceptable is tears .sx For breastfeeding to succeed it must involve so much more than a matter of personal inclination .sx Women all over the world , through no fault of their own , are being tricked into feeding their babies artificially , and this affects us all - our health , our environment and the global economy .sx " Just as people have come to realise that forests are not simply a source for firewood .sx .. so economic planners must learn that human beings are part of the eco system and that something as unnoticed as breastfeeding contributes to a saner management of the earth's resources .sx " .sx BREASTFEEDING .sx SUPPRESSING LACTATION .sx Some women are unable or do not wish to breastfeed for a variety of reasons .sx Jacquie Eaton looks at methods of relief for breast engorgement and pain .sx DESPITE a resurgent interest in breastfeeding , there is a significant number of women who do not breastfeed their babies .sx This may be from personal choice , but may also be because of maternal illness , fetal illness or abnormalities , or perhaps breast disease .sx Some women will have experienced a stillbirth or miscarriage .sx Not breastfeeding may lead to considerable breast pain and engorgement during the days following childbirth , until the time when lactation eventually becomes suppressed naturally .sx Various approaches are to be found which offer relief from the symptoms of engorgement and breast pain .sx Midwives need to be aware of these approaches and to be able to offer appropriate advice to their clients .sx Currently , two types of pharmaceutical methods are being used , and are compared in Table 1 .sx Also , the use of pyridoxine has been compared with a placebo .sx The data available shows it has only limited effect on lactation .sx In the early 1960s , the effect on lactation and breast symptoms of spraying synthetic oxytocin intra - nasally was studied by Ryan and Brown and Winter and Robinson .sx This was not found to be effective .sx Wong et al. studied the effectiveness of a non-pharmacological method of suppressing lactation ( the local application of ice and wearing a tight bra ) to a pharmacological therapy ( using bromocriptine mesylate) .sx Although some subjects in both groups experienced no unpleasant symptoms , most subjects experienced the lactation process .sx The drug group had significantly less engorgement , milk leakage and discomfort on the fourth day , but the lactation process was prolonged until the ninth to 16th post-partum day .sx The protocol group had more engorgement , milk leakage and discomfort on post-partum day four , but the lactation process was completed before postpartum day 16 .sx Brooten compared four treatments ( bromocriptine , tight bra , restricted fluids or binder ) to prevent and control breast pain and engorgement in non - nursing mothers .sx About 38% of all subjects experienced leakage , principally between days three and six post - partum .sx The results showed that significantly fewer subjects experienced leakage in the drug group than in the other three groups .sx Subjects on fluid restriction experienced the most leakage .sx The incidence of breast pain after delivery is shown in Table 2 .sx Irrespective of treatment , the highest incidence of breast pain occurred between the third and fifth day post-partum .sx The drug treatment involved in this study effectively prevented engorgement and pain .sx The commercially available bra was least effective in controlling engorgement and its associated pain , and some women in the trial experienced pain for up to 14 days post-partum .sx When the severity of pain was evaluated , there were no significant differences between the four treatments .sx Two measures for pain relief were used - the application of ice , and analgesics .sx Bromocriptine was found to be more effective in reducing the incidence of pain and leakage of milk associated with breast engorgement than the non-pharmacological methods studied .sx Women in all three non-pharmacological treatment groups experienced pain and leakage , but the differences were not significant .sx The use of a standardised bra appeared to be least satisfactory .sx In Queensland , Australia , midwives carried out a pilot study to compare the outcomes of two non-pharmacological methods .sx Two groups were set up .sx The hospital group consisted of 57 women whose treatment included the wearing of a well-fitting bra or binder , restriction of fluid intake , use of analgesia and avoidance of breast or nipple stimulation from heat , massage or the expression of milk .sx The experimental group comprised 95 women whose treatment involved expressing engorged breasts , either manually or with a breast pump .sx The breasts were either emptied or expressed as often as required for comfort .sx Other traditional methods such as wearing a binder were also permitted .sx The respondents were asked to rate their pain on a four-point scale over a 14-day period .sx The hospital group not only suffered higher levels of pain , but its level peaked a day later than the experimental group and was slower to resolve .sx Both groups were totally free of discomfort by day 11 .sx This study raises questions about the techniques currently employed in the management of the suppression of lactation in the immediate post-partum period .sx The method of expressing milk to relieve symptoms of suppression of lactation offers an alternative and revolutionary approach .sx Additionally , the study shows that , regardless of the approach employed , few women experienced severe pain during this period .sx