By Sara McCall, MPH, CHES, IBCLC
When breastfeeding, inevitably the topic of weaning comes up. “How long will you go for?” “What’s your goal?” “Are you going to nurse until baby is ready to stop?” “You’ll stop before he goes to college, right?” The answers to these questions (except the last one!) are not so simple. Breastfeeding is a relationship between two people – mother and baby. As both evolve and grow throughout the relationship, so do ideas about weaning.
There is usually a time frame involved when discussing the duration of breastfeeding: exclusively at least until about six months of age, then combined with complementary foods to one year and beyond(1) or to two years and beyond (World Health Organization (2). Right from the start, the idea of an end date is planted in the minds of mothers. Often, once mothers reach these scheduled milestones, they find they enjoy breastfeeding too much to stop and decide to keep going. Rarely does a mother say, “I’ll breastfeed until I’m ready to stop.” When this situation arises – that mom is ready to stop breastfeeding but baby isn’t quite there yet – complicated emotions may develop.
What is weaning?
Depending on culture, weaning may be defined as introducing foods other than human milk to a baby or stopping breastfeeding entirely(3). For the purposes of this article, we will discuss weaning as ending all feeding at the breast.
Natural weaning, sometimes called child-led weaning, occurs when the child no longer has an emotional or nutritive need to breastfeed.(4) This usually doesn’t occur before 18-24 months of age. Letting the child set the pace for weaning allows him to reach the developmental milestone of weaning on his own timeline. Though the child may ultimately decide when the breastfeeding relationship is over, this does not mean the mother sits by passively. As with any relationship, there is an element of give-and-take in the breastfeeding relationship. Mothers can set limits as the child grows older, such as only nursing at certain times of the day or asking the child to wait until mom is finished with a meal or task. Natural weaning is an intricate dance between mother and child that can take months or sometimes even a year or more to play out.
Mother-led weaning happens when a mother actively encourages weaning before a child is naturally ready. This may be done by increasing the use of a bottle or cup, offering food/drink besides human milk, or limiting nursing.
When NOT to wean
It’s important to note that there are several common reasons mothers give for weaning that may not be in the best interests of both mother and child. These include:
- Pressure from others: Friends and family will have their own opinions about when a mother should wean her baby. They are not a part of the nursing relationship and shouldn’t be given power in this decision. If you’re finding it difficult to handle the opinions of friends and family, you may be able to find mother-to-mother support through a Breastfeeding USA Counselor.
- Misinformation: Some women are told their milk isn’t nutritional after the baby reaches a certain age. Does broccoli stop being healthy after a certain age? No, and neither does your milk. Other myths told to mothers include that she’s only doing it for herself; the child doesn’t need breastfeeding after a certain age; breastfeeding past a certain age is bad for the child; or that breastfeeding is the reason she is [insert problem/ailment here]. Talking to a breastfeeding counselor about nursing concerns can help women from prematurely weaning due to faulty information.
- Pregnancy: It is generally considered to be safe to breastfeed while pregnant. According to Dr. Bob Sears, breastfeeding during pregnancy may not be safe for “moms who have a history of miscarriages or preterm labor (labor beginning before 37 weeks gestation) with previous pregnancies (5).”
- Nursing strike:Children who self-wean rarely stop abruptly. If your child suddenly refuses to nurse, chances are it is a nursing strike, rather than weaning.
- Distractibility: Older babies and toddlers become fascinated with the world around them and will sometimes be too distracted to nurse. This does not mean they don’t need the breast anymore – it just means they may need some help focusing on the task of nursing for a while. Moms can help their babies focus by nursing in a quiet, darkened room; trying a new position; or wearing a “nursing necklace” that gives baby something to play with while nursing.
- Going back to work or school: Even if you aren’t able to express milk while away from your child, this does not have to mean the end of breastfeeding! You can still breastfeed during the times you are with the child. When mom is away during the day, some babies do what is called reverse cycle breastfeeding: nursing frequently at night and less frequently during the day. Continuing to breastfeed during those times may help both you and baby reconnect after you have been separated. For more information on how to express at work or school, check out the “Expressing Your Milk” section of Breastfeeding USA.
Why wean?
One important reason that a mother might begin the weaning process is that her feelings about breastfeeding have changed. Amber recalls, “One day I realized that I wasn’t enjoying breastfeeding anymore. My nipples had become very sensitive, which made sex difficult to enjoy; I wanted to lose weight but was fearful that dieting or exercising too much would affect my milk; I was tired of only being touched when someone wanted something from me; I was tired of being woken up in the night and early in the morning; I was tired of having to sleep with a bra on . . . but I was determined to finish out my daughter’s first year and avoid putting her on formula.”
Brandie notes that when she reached her goal of one year, she was “just plain ready” to wean, but that “it was an emotional time and a long process that dragged on for months. I think I was ready to wean before my son was, but it was a two-person effort. We didn’t successfully wean until he was ready.”
If a mother starts to have negative feelings about breastfeeding, it’s important to explore them. Many women will try to stuff them away, afraid of being labeled selfish or a bad mother. However, keeping those feelings in the dark only allows them to grow stronger.
Amber continues: “I pushed through my growing aversion to being touched and continued to breastfeed my daughter. I started to feel some resentment towards her, especially when she would prolong the experience by looking around like she was done, then fussing if I put my breast away, and I hated when she would reach her little hand over to my other nipple and remind me that she needed her nails cut. My resentment eventually turned to fear: would this experience affect my desire to breastfeed other children?”
The complicated emotions of weaning
The decision to wean is not an easy one. It can help if a mother can identify what she is feeling and then accept those feelings without judgment. Disliking or resenting breastfeeding does not make a woman a bad mother. Next, it might be helpful to talk about these emotions with a breastfeeding counselor or a trusted health-care professional. The decision to wean isn’t one that should be made lightly, and talking about it with someone knowledgeable about breastfeeding can help a mother make an informed decision. It’s much easier to continue breastfeeding when you are unsure, than it is to stop and then try to relactate later.
When a woman decides to stop breastfeeding, she needs to know about the physical aspects to watch out for: engorgement with an increased risk of clogged ducts/mastitis. But many mothers are surprised at the intense emotions that can accompany this change. Some mothers, like April, report a mixture of emotions when their child doesn’t need to nurse anymore. A woman may feel nostalgic, sad, or depressed when breastfeeding ends, even if she is the one who made the choice to stop.
Hormonal changes play a part in this. Breastfeeding increases the levels of both prolactin and oxytocin, hormones that create feelings of well-being, calmness, and relaxation in most women. As weaning occurs, these hormone levels will drop, often producing emotional effects. Gradual weaning will help prevent a sudden drop in levels. Oxytocin levels increase during cuddling, hugging, and kissing – all activities that should be encouraged during the weaning process.(6)
In addition to hormonal influences, mothers may feel sadness because weaning marks a change in the mother-child relationship. Breastfeeding is one thing that only the mother can offer, and weaning is an end to that part of mothering. It’s common to miss the connection that breastfeeding provided. Sometimes, if mother-led weaning goes “too easy,” a mother can feel hurt by the child’s lack of concern for stopping nursing. Lisa shares, “I wanted to wean but still felt so guilty and sad. The first full two days that he didn’t nurse, I cried all day!” Weaning may trigger a depressive episode in some women, especially if there is prior or underlying depression.(7)
Along with sadness comes the guilt. When a mother decides to stop breastfeeding, she knows she is taking something important from her child. There are two people in a breastfeeding relationship, but it is extremely difficult for most mothers to put their needs ahead of the needs of their baby. The importance of breastfeeding cannot be overstated, but if it is beginning to contribute to negative emotions in the mother-child relationship, then a mother must be empowered to explore these emotions without fear of judgment.
Tips for healthy weaning
If you are thinking about weaning, be prepared for the mélange of emotions that may occur. There are ways you can make this a smoother transition for both you and your child.
- Wean gradually. Drop one feed at a time, with plenty of time in between. Sara estimates that her weaning process took about 4 months. Weaning gradually will protect mother from physical problems, as well as give the child ample time to adjust to the change. Also, if you start dropping feeds and then decide you aren’t ready to fully wean, you’ll be able to continue breastfeeding more easily.
- Find new ways to comfort your child. Your child needs emotional support from you; nursing was one way to provide that. Without nursing, you’ll need to find other ways to comfort your child. Cuddling, hugs, and singing are all good ways to offer comfort without the breast. Enlist the help of your partner or family member, if available, to give your child more attention and skin-to-skin contact.
- Talk to someone. If you are struggling with depression, sadness, anxiety or other strong emotions, find a trusted confidant such as your partner, another family member, a close friend, or a Breastfeeding USA Counselor. If your symptoms persist, consider seeing a health-care professional for additional support.
- Take care of yourself. Eat a healthy, well-balanced diet. Try to get enough sleep. Get outside to enjoy nature. Physical activity is a great way to improve mood through the release of endorphins. Do something special and fun with your child, such as taking walks, going to the park, or another activity your child enjoys.
- Commemorate your breastfeeding experience, especially with an older child, through a weaning ceremony. The Leaky Boob, a popular breastfeeding blog, has some great examples of weaning ceremonies. Writing your nursing story, getting body art, buying/making a special piece of jewelry, and performing ceremonies/rituals are all ways mothers have honored the end of their breastfeeding relationship.
No matter how weaning begins and ends, child-led, or mother-led, or a natural combination of both, it is often a process of great significance for all involved, including other family members. Every child weans at some point. For a fulfilling breastfeeding relationship, weaning needs careful thought, consideration of needs, open discussion, and caring responses.
References
1. American Academy of Pediatrics. (2012). AAP Reaffirms Breastfeeding Guidelines.
2. World Health Organization. (2013). WHO | Breastfeeding.
3. Greiner, T. (1996). The Concept of Weaning: Definitions and Their Implications. Journal of Human Lactation, 12, 123-128.
4. Bonyata, K. (2011). Do Babies Under 12 Months Self-wean?
5. Sears, Bob. (2013). Breastfeeding While Pregnant.
6. Bonyata, K. (2011). Comfort Measures for Mom During Weaning.
7. Sharma, V. and Corpse, C. S. (2008) Case Study Revisiting the Association Between Breastfeeding and Postpartum Depression. Journal of Human Lactation,24(1),77-79.
Sara McCall, MPH, CHES, IBCLC
Sara is the mother of one breastfed child (with another one due summer 2014) and an IBCLC living in Abilene, TX.
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