Dombroski hot , cold, depleted or deluded

Hot , Cold, Depleted or Deluded?Understanding and accepting Chinese breastfeeding beliefs

Kelly Dombroski

The Study: Background• PhD thesis on mothering practices

in the northwest Chinese city of Xining• Economic activities of mothers• Nappy-free baby hygiene• Infant feeding• Embodied knowledge

• Australian cohort practicing a version of nappy-free hygiene/early infant toileting

• Qualitative research, Human Geography

The Study: Findings Summary (Infant feeding)

• Women in Xining influenced by two main discourses• Traditional Chinese Medicine• Biomedicine

• Equally ‘universalistic’• Both discourses claim to fully support

breastfeeding• Yet despite recurring scandals in the

artificial formula sector, sales are still growing rapidly

The Study: AnalysisResearch question for this paper:Why do two perspectives fully

supporting breastfeeding interact to produce less breastfeeding?

And

What are some strategies we can engage to address this?

Traditional Chinese Medicine

“Health and disease are directly associated with the balance of yin and yang

… yin represents the passive and receding aspect of nature whereas yang represents the active, advancing aspects of nature. It is believed that yin and yang exist at the emotional, physical, interpersonal/ societal, and ecological levels

… the two forces are thought to be interdependent, and the imbalance between them results in disease.” (Chen and Swartzman, 2001: 391)

Traditional Chinese Medicine

Wood Fire Earth Metal Water

Yang Organ

Liver Heart Spleen Lung Kidney

Yin organ Gall bladder

Small Intestine

Stomach Large intestine

Bladder

Senses Eye Tongue Mouth Nose Ear

Tissue Sinews Blood vessels

Muscles Skin Bone

Climatic qi

Wind Heat Damp Dryness Cold

Flavours Sour Bitter Sweet Pungent Salty

Emotions Anger Joy Worry Grief Fear

Traditional Chinese MedicineTable 1: Sample of inter-relating concepts and processes according to TCM

Source: Author, after Men and Guo, 2010

• Breastmilk pure, perfectly digestible• Linked to the chong and ren meridians• Breastmilk produced via the blood system• But can be affected by changes in qi• Important not to overburden immature

digestive system with ‘inappropriate’ milk – limit certain foods, emotions, and activities, or delay breastfeeding after these.

TCM and Breastmilk

The First Feed

• Breastfeeding should be initiated in the delivery room ‘if mother and baby are both healthy’• Yet most of my participants delayed by

1-2 days.• Healthy? Rare – birth ‘depletes’ a

mother, mostly through blood loss• This depletion affects her milk (since it’s

the one system – downward flow = blood, upward flow = milk)

• Who judges depletion? Mother/grandmother. Blood loss, cold, c-sections, trauma, anxiety = delayed feeding

TCM and the first breastfeed

• TCM = delayed first feed. Few problems traditionally – could be up to 3 days while mother recovers.

• Biomedicine = concern babies will become hypoglycemic and unable to feed – some actual cases especially in rural areas.• Treated with sugar water (spooned)

• TCM + Bio = conceptual opening for non-breastmilk substances.• Artificial formula means baby will not be

hypoglycemic, mother will have chance to recover.

TCM and Biomedicine: First feed

• Strategies:• Negotiating delay in first feed?• Providing or suggesting blood

nourishing foods and practices, especially for c-section or traumatised women.

• Being respectful of women’s concern for her health as well as the health of the baby.

• Getting grandmother and husband on side – demonstrate your desire to balance the health of mother and baby.

TCM and Biomedicine: First feed

“How do you feel?’ Listen for words like ‘depleted’ ‘drained’ ‘tired’

“You have lost some blood, so let’s make sure you get the nourishing food you need. Do you have someone to bring food in for you?”

“You have been through a pretty draining experience, make sure you take some rest and recover your body, and in a while we will try to feed baby a little”

“We need to balance your needs for recovery with baby’s need for sucking – at this stage baby is not taking a lot so should be OK as long as you rest”

Dialogue

Blood, Milk, and Nourishment as Baby Grows

TCM: Blood, milk and nourishment as baby grows

• Milk quality and quantity related to both blood and qi

• ‘Bad’ milk related to ill health, emotional states, seasonal changes in milk• ‘bad’ can refer to both quality and

quantity• Self-diagnosed through

• baby’s behaviour (unsettled, hungry signs, vomiting, abdominal pain, continuous feeding)

• Mother’s feeling (anxious, uncomfortable, empty)

• Treated through nourishing foods, rest, acupuncture, counselling

TCM and Biomedicine: nourishment as baby grows

• TCM= low supply/bad milk exists and can be easily treated through diet, rest, acupuncture, herbs

• Biomedicine= low supply/bad milk does not/rarely exists. Just feed the baby more frequently.

• TCM + Biomedicine = gap for breastmilk substitutes• Woman feels there is a milk quality or

quantity problem but is offered no treatment options bar ‘more feeding’

• Often results in supplementing with formula (sometimes temporary)

TCM and Biomedicine: nourishment as baby grows

Strategies:• Recognising the felt needs of the mother,

and balancing these with baby.• Talk about feelings – shock, anxiety, anger

are particularly relevant. Refer for counselling. Enquire about support.

• Suggestions for boosting supply – rest, protein (particularly lamb), refer to TCM practitioner/acupuncturist

• Aware of foods that cause discomfort in baby – TCM has lists of foods that can unsettle baby (mother’s diet or baby’s diet). Similar to common allergy foods (wheat, dairy, salicylates) and gassy foods (certain vegetables and pulses)

Dialogue• “How do you feel about your milk?” listen

for words like ‘watery’ ‘bad’ ‘unsettled’ , ‘crying’, ‘empty’

• ‘Being a mum can be pretty tiring and worrying – have you been worried about anything lately?’

• ‘Babies have sensitive tummies, is there anything you are eating that could be unsettling baby?’

• ‘I prescribe you (period of time) rest. I want you to rest in bed with baby every afternoon, and just concentrate on recovering from your illness and feeding baby – resting will help restore your supply.’

First Solids and Weaning

TCM: First Solids and Weaning • First solids introduced not for nutrition,

but to ‘promote digestion’ (medicinal)• Digestion is the theme throughout

introduction of solids – soft, bland, easily digestible

• Traditionally, breastmilk main source of nutrition until one year, breastfeeding could continue until 7 years old.

• Weaning processes emphasise easily digestible foods, supplemented with a wide variety of ‘tastes’ of adult food.

TCM and Biomedicine: First Solids and Weaning • TCM= focus on digestion and avoiding

overburdening digestive system• Biomedicine= stark contrast between

‘exclusive breastfeeding’ and solids for nutrition

• TCM + biomedicine = gap for breastmilk substitutes • because artificial formula is both

easily digestible and nutritious• Because women have already ‘failed’

at exclusive breastfeeding

TCM and Biomedicine: First Solids and Weaning

Strategies:• Distinguish between purpose of

solids given – as substitute for milk, or digestive aid just once or twice?

• Try not to force things in to ‘either/or’ decisions

• Suggest (or ask for suggestions of) foods that are both nutritious and easy to digest.

• Emphasise the ‘perfection’ of breastmilk as both nutritious and digestible, and suggest nutritious additions to the mother’s diet so she feels her milk is high quality.

• Refer to TCM practitioner if appropriate

Dialogue• How is baby’s digestion going? How

does baby react to different foods you are trying?

• How do you feel about your milk? It must be reassuring that baby can still get all their nutrition needs met from breastfeeding as they get used to digesting different foods.

• How are you looking after yourself? Are you eating well? Resting?

TCM and Breastfeeding in Australia

TCM, Biomedicine, and Breastfeeding• Differences primarily differences in how

one ‘knows’ not in the quality of information or education.

• Breastfeeding is a deeply embodied experience, and listening to what women are feeling is very important.

• Women from Chinese backgrounds may be drawing on quite different bodily experiences and knowledge traditions.

• Ignoring or belittling these can lead to breastfeeding failure or early weaning.

ABA and TCM: My Opinion• ABA is not a medical organisation – it is

primarily a support organisation• Medical research does not (and cannot)

cover many aspects of the embodied breastfeeding relationship

• TCM has a long history, and will probably not be replaced by biomedicine

• We should be supporting breastfeeding relationships pragmatically and not dogmatically, whatever the cultural or medicinal tradition of our subscribers.

[email protected]@uws.edu.au

All photos © Kelly Dombroski