The Washington PostDemocracy Dies in Darkness

The solution to formula shortage isn’t calling for more breastfeeding

Claims that mothers lacking formula should just breastfeed repeats a centuries-old mistake

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The United States is suffering from severe shortages of baby formula — the nationwide out-of-stock rate has reached 43 percent. This shortage has alarmed parents and left some pleading for help on social media. But instead of offering help, many have instead lobbed insults and accusations at mothers, deriding them as inadequate parents for not breastfeeding. Even actress and singer Bette Midler tweeted, “TRY BREASTFEEEDING! It’s free and available on demand.”

While the formula shortage is new, attacks on mothers who don’t breastfeed are not. In the second half of the 18th century, the cultural image of a tender, sentimental mother — one who nursed her own children — became entrenched in popular imagination. This powerful image emerged in part due to the advice of medical manuals circulating in Britain and its American colonies that recommended breastfeeding over the alternative at the time, wet nursing. Male physicians vilified mothers who did not breastfeed as vain, neglectful and even monstrous. These physicians presented breastfeeding as a simple choice, but the reality was much more complicated and these texts unfairly impugned mothers who wanted what was best for their children. Ultimately, physicians’ ideas about breastfeeding said more about the imperial goals of European states than the lived realities of motherhood. The critics of non-breastfeeding parents in 2022 are repeating this centuries-old mistake.

Breastfeeding could be a perilous and painful pursuit in the 17th and 18th centuries, and mothers could choose from a variety of devices to treat issues that befell lactating breasts. Nipple shields made of wood or sterling silver were covered with a cow’s teat and worn to breastfeed, while nipple caps made of wood or beeswax probably soothed chapped nipples during pregnancy or immediately before or after breastfeeding. Breast pumps and glasses expressed obstructed milk ducts, while plasters and surgical tools could relieve breast pain from abscesses. However, if a mother’s main problem was a low milk supply, these devices could not help. But employing a good wet nurse — a lactating woman who got paid to breastfeed other women’s babies — could.

For the upper echelons of European society, hiring a wet nurse was a normal part of motherhood in the medieval period. The labor of a wet nurse was a luxury and a status symbol, and by the early modern period, middling classes could sometimes afford this labor as well.

Yet, in the 17th century, European physicians began criticizing the practice and arguing that maternal breastfeeding was preferable and more natural than wet nursing. In his 1651 text, “A directory for midwives,” English herbalist and physician Nicholas Culpeper argued that a woman who did not breastfeed “cannot love her Child; which if she do not, the more inhumane Beast she.” While midwife Jane Sharp acknowledged in her 1671 manual, “The midwives book,” that it was normal for wealthy families to send their children away to be cared for by wet nurses, she claimed the practice changed “the natural disposition of the child.” She conceded that some women could not physically breastfeed, but asserted that many women who believed they were incapable could nurse if they simply tried harder. Instead, they were unwilling because they didn’t love their children as much as “Dumb creatures” — animals — did. These comparisons illustrated broader societal understandings of breastfeeding that continued in the 18th century.

Physicians’ manuals often accused women who employed wet nurses of vanity and selfishness — according to these doctors, women did not want breastfeeding to alter the appearance of their breasts, and wet nurses also freed them to pursue social activities. This literature accused these mothers of loving neither their children nor God sufficiently. Like Sharp, the anonymous author of “The Ladies Physical Directory” (1739) compared them negatively to animals — including lions, wolves, tigers and bears. These creatures, even as they embodied viciousness, also exemplified natural, self-sacrificing maternity because they were willing to “almost starve themselves, rather than leave and deprive their Young of their Milk.” By contrast, women purportedly chose a plethora of activities and priorities — including fashion, plays, operas, assemblies and masquerades — over breastfeeding their own infants.

These physicians often assumed women did not know the abilities of their own bodies well enough to decide to breastfeed their own children. “The Ladies Physical Directory” asserted that while some women could not physically breastfeed, many who thought that they were unable to do so were mistaken — they simply had hysterical constitutions or were easily discouraged by nipple pain. He encouraged his readers to use his “Healing Balsam,” an ointment that served as a treatment and preventive that enabled maternal breastfeeding. In his estimation, nipple pain was “the only material Inconvenience of suckling Children,” and his treatment recommendations would cause mothers to rethink their objections to breastfeeding, thereby saving the lives of their infants.

Fear about the dangers of wet nursing drove much of this commentary. These experts said children would acquire the mental, physical and emotional qualities of a wet nurse through her breast milk, direct contact with her body or through imitating her mannerisms. Sharp warned that nurses with perceived physical deficiencies would transmit those conditions to the child, who would “partake of by sucking such ill qualified milk as such people yield[.]”

Part of the fear surrounding wet nursing lie in the possibility that wealthy children would grow up with mannerisms that were beneath their social class. “The Ladies Physical Directory” advised maternal breastfeeding as the most natural option for newborns in part because the practice would maintain children’s resemblance to their parents. When parents chose wet nursing, the author noted that they often complained that their children did not resemble them. He reminded readers to consider that “they might easily trace their ill-turn’d Thoughts, inordinate Desires, vicious Inclinations, and evil Passions of Mind, to the Nurses who gave them suck.” He warned that such mental changes could not be remedied by the “most polite future Education.”

A key moment in the assault on wet nursing came when British physician William Cadogan published “An Essay upon Nursing” in 1748 (it didn’t reach the American colonies until 1750). In this piece, Cadogan lamented that nursing had been “too long fatally left to the Management of Women.” Most mothers, he argued, either could not or would not “undertake the troublesome Task of suckling their own Children.” Like earlier critics he charged that vanity — an unwillingness to “give up a little of the Beauty of her Breast” kept women from feeding their children. Cadogan even advised his male readers to supervise the management of the nursing of their children to ensure that their wives complied with Cadogan’s best practices.

But these publications grossly distorted the lived realities of colonial American motherhood, especially for poor women, Indigenous women and enslaved women of African descent, and misunderstood why women employed wet nurses. White women in England and early America employed wet nurses to achieve an idealized version of motherhood — they saw wet nursing as crucial, not antithetical to, being a good mother. Even if the milk that nourished her child came from a wet nurse, the mother still chose and supervised the nurse to ensure the best possible care for her child.

Yet male physicians misconstrued these efforts and harangued the women’s character, accusing them of being bad mothers or worse.

This history offers a lesson for critics of parents frantically seeking formula today. It was wrong then to assume that women who didn’t breastfeed were selfish or shirking maternal duties, just as it is inaccurate now. There was no idyllic American past in which every mother breastfed effortlessly, just as everyone cannot breastfeed effortlessly now. These misguided assumptions wrongly impugn parents’ love for their children. Even worse, much like 17th- and 18th-century popular misconceptions, these criticisms infringe on women’s bodily autonomy by cruelly assuming they do not know — or care about — what is best for themselves or their children

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