Maternal expectations: new mothers, nurses, and breastfeeding.

Abstract. By the middle of the 20th century, breastfeeding rates had fallen to less than 20% in some areas of the United States. Despite these grim statistics, many mothers continued to seek information, advice, and the experience of breastfeeding their infants. This article explores the role that nurses played in these women's struggles to breastfeed in the years between the end of World War II and the 1970s. The role of the nurse in shaping the meaning and experience of breastfeeding in America has been an important, albeit often overlooked, part of the history of infant feeding. In addition to exploring the ways in which hospital policies and structures shaped nurses' relationships with breastfeeding mothers, this article looks at how different maternal ideologies influenced the nature of these (mostly) same-sex interactions. This article argues that the ideas about, and experiences with, motherhood had important implications for how nurses and mothers approached the practice of breastfeeding in the hospital. During a workshop on breastfeeding held for nurses and nursing students in 1967, instructors Loraine Dyal and Julia Kahrl set out to tackle some of the issues that prevented nurses from being effective breastfeeding supporters. The most pressing item on their agenda was to help the nurses work through the inhibitions and discomforts many seemed to have when it came to their breastfeeding patients. Dyal and Kahrl encouraged the nurses to "evaluate their own attitudes toward breast-feeding" and asked them to consider their own personal history with the practice. Had they been breastfed? Had breastfeeding been a part of their family experience as a child?1 Many experts, including physicians and nurses, agreed (at least in theory) by the late 1950s that the best way to get a mother to breastfeed successfully was through calm and consistent encouragement from the period immediately after birth throughout the first weeks and months of new motherhood. 2 Providing this kind of support in practice, however, often provoked discomfort, embarrassment, insecurity, impatience, and misunderstanding for nurses confronted with a breastfeeding mother in the hospital. In the pages that follow, I explore the complicated role nurses played in the history of breastfeeding from the years following World War II through the 1960s and early 1970s. During these years, the United States was plagued by extremely low breastfeeding rates, because formula had long since become the "normal" way of feeding an infant.3 These years also witnessed dramatic changes in American culture, nursing education, and practice, as well as in the labor, delivery, and postpartum experiences of mothers. My argument pays particular attention to the specific interaction between hospital nursing staff and new mothers and their babies in the moments, hours, and days following labor and delivery. In the years after World War II, when hospitals sprouted up by the hundreds, nursing became deeply embedded in the structure of the health care system itself, invisibilized by its nature as caring labor.4 Illuminating the nurse and the labor of caring within the structural hierarchy of the hospital continues to pose challenges to historical investigations of nursing and health care. However, through a postpartum mother's eyes, the nurse was an allimportant figure: the gatekeeper to her infant and to her dreams of what kind of mother she would be-a breastfeeding mother or a bottle-feeding mother? For the nurse, this influence may have been unwelcomed or unnoticed; alternatively, perhaps some nurses actively (or even unknowingly) wielded their influence to favor breastfeeding over bottle-feeding, or vice versa. Scholars must resist the temptation to continue to participate in the fallacy of the invisible nurse. Although nurses have often escaped historical attention and scrutiny because of their subordinated positions in the hospital hierarchy, it is unrealistic to assume that they did not exert agency or participate in decision making that influenced the experiences of their patients. …