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Pleasure and Purpose The Sensuousness of Breastfeeding
facts and opinions Pleasure and Purpose The Sensuousness of Breastfeeding JANICE M. RIORDAN, RN, MN, and EMILY T.RAPP, MS
By examining sexualio in breasrJeeding as a reinforcement to ensure the continuip of the human species 0s well as promoting spacing between pregnancies, the aulhors review cross-cultural perspectives, physiologv, and research on this topic. Individual responses from breaslfccding women are also reported to enlarge the nurse’s understanding o$a dimension of human behavior not usualb acknowledged.
Human biology and life patterns are constantly in cyclic progression. We sleep, wake, experience changes in body temperature, blood sugar, and blood pressure in a synchrony of predictable rhythms. These cycles and rhythms, in their certain inevitability, have purpose for our life functioning. We can say also that in feminine reproductive function there are five cycles: ovarian, intercourse, pregnancy, childbirth, and lactation.’ Each of these has purpose a n d brings pleasure if experienced at an optimal level of function for the individual. The objective of this article is to explore the hypothesis that one of these, breastfeeding/lactation, is a sexually pleasurable process for the mother in addition to providing nourishment for her infant. Included in this hypothesis is the assumption that the very survival of Homo sapiens has been dependent on these sensual reinforcements of breastfeeding. If it were not so, man would have joined the dinosaurs in extinction long ago.’ That sexual pleasure should occupy the minds of nursing mothers may come not only as a novel, but also as a shocking, idea. Yet, in perusal of the many paintings of nursing dyads that abound in collections March/April I98OJOCN Nursing
Oogo-03I 1 /80/03 19-0losf0100
of great art, we may note a mood of introspection and a faint, bemused expression of pleasure o n t h e mother’s face, indicating that we may have been “looking but not seeing.” As a corollary, we will explore the notion that these energies being channeled into the breastfeeding experience are shunted away from other forms of sexual expression such as coitus and that this, coupled with the suppression of the ovarian cycle, is nature’s effort to prolong spacing between pregnancies, thus helping to ensure nourishment and nurturing for the infant for a longer period of time.
Cultural Perspectives Because cultural attitudes are intimately associated with the expression of feminine biological functions, sensual enjoyment during breastfeeding must be examined from a cross-cultural perspective. Attitudes toward breastfeeding and sensuality show considerable variation among different cultures, being developed in some, muted in others. T h e Navahos, for instance, have highly developed sexual innuendos. K l u c k h o h n ’ observed t h a t boy babies were observed to have erotic interchanges with their mothers with
penile erection during breastfeeding. In contrast, women of Alor in the Oceanic, “do not speak of the erotic pleasures of nursing.”’ In counseling lactating women in a midwestern community, the author has found the last statement to be descriptive of attitudes in this area and, from participation in national seminars on breastfeeding, the dominant attitude in the American culture. If specific sensual feelings are ever discussed, it is usually with hesitation, embarrassment, and in privacy. Under these conditions, one mother stated, “My breast, and especially my nipples, are more sensitive in sex now that I’ve nursed two babies t h a n before. Somewhere along the way, I learned that sucking felt good.” In many primitive cultures, concerns about sensual feelings are preempted by the expectation that lactation inhibits ovulation, offering a n a t u r a l s p a c i n g between pregnancies. Despite the considerable controversy on this subject, repeated studies in unrestricted breastfeeding, i.e., feedings that proceed without rules that restrict sucking and typically occur 8- 12 times per day, show t h a t ovulation is delayed 6-22 months.’’ Several cultures feel so strongly about spacing children and t h e need for recuperation, that 109
coitus is strictly prohibited throughout the lactation period. Our own cultural denial of sensua l i t y during breastfeeding is revealed in the almost total absence of reference to it in the growing body of sex literature. As a n example, Richard Green, the male author of two major books on sexuality, limits his discussion of sexuality during the postpartum period to: “Sexual interest in women will probably be low in the immediate post partum period. T h e return of sexual interest in coitus is variable.”” Recognition of sensuality during breast feeding is not broached in any of the major textbooks on sexuality; an astounding myopia in the light of current data that approximately 50% of all women presently breast feed their babies.’ Indeed, most research and observations are derived from the single male biological function: ejaculation through intercourse or masturbation. Is this glaring omission the result of ignorance or is it the threat to males that the feminine sexual cycles are so rich and varied?
Women’s Feelings About Sensuality A considerable body of objective evidence suggests that maternal attitudes are related to breastfeeding behavior and sensuality as a whole. Newton” reports that aversion to breastfeeding appears to be related to dissatisfaction with the woman’s lot in life, length of labor, desire for intercourse, smaller size of families, and the actual amount of milk secreted during lactation. Deutsch states: Personally I am convinced that by far the greatest part of nursing difficulties are psychogenic. . . that in the nursing period the psychic umbilical cord connects the mother’s breast and the child’s mouth and that it runs through the arena of the conflict between egoistic tendencies and the altruistic forces of motherhood.’
Another factor has been the emphasis which some members of the women’s movement have given to liberation from maternal roles. These individuals fear that a recognition of the nonorgasmic aspects of female sexuality would be counter110
productive, leading to a return of the “motherhood myth” which domesticates women and limits their potential outside the home. Instead, orgasmic liberation, rather than the fight for women’s rights to give birth and breastfeed free of medical (and mainly male) interference and cultural pressures, has received the most emphasis.“’
Erotic Stimulation T h e close relationship between sensual feelings and suckling at the nipple is real enough. T h e nipple is well supplied with nerve endings and their stimulation by the nursing baby causes uterine contractions which, in t h e early postpartum weeks, helps involution of the uterus to its pre-pregnancy state. This interrelationship between the breast and the lower reproductive tract has been r e p e a t e d l y d e m o n s t r a t e d . Oxytocin, the hormone released during the ejection of milk or let-down, causes the uterine muscle fibers to contract rhythmically during breastfeeding. During the early feedings following birth, these contractions are usually felt as strong and painful cramps; l a t e r t h e painless contractions continue for about 20 minUtes after the feeding. Conversely, failure to experience uterine contractions indicates inadequate letdown which leads to engorgement which in turn leads to inadequate milk supply. Further evidence of this relationship is the effect of lower reproductive tract stimulation on milk flow. For example, vaginal stimulation is a recognized way for dairy farmers to induce milk flow in cows, and there are reports from human mothers of dripping or spurting of milk during heightened sexual response and orgasm. Other similarities of physiologic responses between sexual arousal and breastfeeding are the erection of the nipples with marked vascular changes, lengthening of the nipple, rhythmic stroking of the nipple during sucking, and extensive skin-toskin contact. Masters and Johnson found that this stimulation was reported by some women to have brought them to plateau levels of sexual response and, on several occasions, to orgasm.” Since birth is the
beginning of a long intimate relationship between a mother and her baby, is it unreasonable to expect it to be physiologically pleasurable like the sexual pleasures at the beginning of a long, intimate, and committed relationship with a mate? Despite this tenable notion, guilt is a common response to these feelings. Six of the 24 women studied by Masters and Johnson expressed guilt feelings over their sexual arousal. Just as some religious beliefs prescribe procreation as the ruison d’etre for the enjoyment of intercourse, nourishment is often regarded as the sole purpose of the breastfeeding act. T h e exact nature of the sensual feelings during nursing should be differentiated from coital arousal. Interviews with lactating women indicate that sustained erotic stimulation and/or orgasm is not the usual experience. Although the nipple itself is very sensitive” during feedings, much stimulation falls upon the areola which is comparatively insensitive to touch. Intense anticipatory erotic sensations are unlike the tranquil and peaceful sensual feelings described by mothers following the let-down of the milk. In response to a question regarding erotic feelings during feeding, one mother stated: If I don’t have the baby positioned right, and he starts gumming the nipple, sure, I begin to feel just like I do when my husband stimulates my breasts when we make love. But it gets in the way, this feeling, as here I am sitting and waiting to let down my milk and I’m getting more and more tense. I just shift the baby around until he’s got the entire areola and then we have a good feeding.
Unfortunately, some women who experience sensual feelings during nursing feel guilty to the point that they voluntarily wean their babies early and refuse to nurse future children. T h e question now arises: Why don’t some mothers feel sensual during nursing even though they have nursed several months? Are they intimidated by social expectations and not admitting it, or in fact, is nonsensuality just another response in March/April 1980JOCN Nursing
the wide range of possible feelings? On e such mother confided, “Although I nursed, I never felt that it was in any way sexual for me. It brought me no particular pleasure, but on the other hand, it wasn’t unpleasant either.” O n e possible explanation is that a woman whose breast a n d nipples are not normally erogenous zones is not likely to become erotically stimulated by the suckling of her infant.
Breastfeeding and Sexual Relations Receptiveness of t h e n u r s i n g mo th e r t o coitus a n d sexual expression with her mate is reported in the literature to be increased or diminished, depending on the source. Masters a n d Johnson found that breastfeeding women, as a group, reported a prompt return of sexuality a n d a return to higher levels of sexuality than bottlefeeding mothers. I ’ However these responses were not measured physiologically. I n another study,” three-fourths of t he s a m p l e d m o t h e r s r epor t ed t h a t breastfeeding had little effect on their sexual lives. O u r own experience a n d that of others in counseling mothers seems to indicate that sexual desire, at least on the part of the nursing mother, lessens considerably during lactation. Describing her feelings during this period, a mother reported: When you are home and you touch, hold, hug, and nurse all day, you’re not so interested in it when your husband walks through the door. But then his day has been all talk all d a y a n d n o touch a n d he’s ready. It creates a problem.
Observations of mating behavior of animals supports this theory. T h e majority of lower mammalian females do not normally become receptive until their young are weaned.”’ Nervous stimuli evoked by suckling appear to prevent the secretion of gonadotropic hormones from the pituitary a n d as a result, the ovaries d o not produce the sex hormones necessary to mating behavior. Female mice, for example, nurse their young for ab o ut three weeks a n d then estrous cycles and sexual receptivity reappear. O n the other hand, this mother gave a different view: March/April I98OJOCN N u r r q
To me sex is best of all during the later breastfeeding period because I feel physically better than at any other time, and there is n o need for c o n t r a c e p t i v e s b e c a u s e for me, breastfeeding is a 100% effective contraceptive for a b o u t a year. There’s something about nursing a little baby that gives you a n “all’s right with the world” feeling. I feel so happy a n d loving toward my whole family as well as the baby. Sex just seems to be a nice, natural expression of this good feeling.
This apparent wide variance of sexual responsiveness may be due to the following reasons. First, because of the importance of the Masters a n d Johnson research as a whole, any dat a derived from their studies is frequently referred to, a n d is accepted, as valid. However, in the Masters a n d Johnson study cited above, only 24 reports by lactating women were studied, hardly a population sample for any statistical significance-a point which the authors themselves clearly make in the text. Also, the halo effect of participation in o n e segment of m uch wider sex studies cannot be discounted. O n the other hand, when physiological changes were measured on the nursing breast during sexual tension from general stimulation, n o consistent size increases were noted in the Masters a n d Johnson studies.” Second, the Ford and Beach theory, that the clear-cut relationship between fertility a n d sexual responsiveness in lower mammalian species is less well defined in subhuman primates a n d is completely obliterated in the human female, may account for the heightened sexual response reported by some women. It could be t h a t w o m e n w h o choose to breastfeed, as a group, possess a greater interest in coitus throughout their entire reproductive cycle than women who, because they are uncomfortable with their total sexuality, prefer to bottle feed. Certainly the exhaustion a n d anxiety of t h e new m ot her with a n added work load, interrupted sleep, a n d concern about her ability to car e for her baby would understandably cause a drain on her li-
bido and sexual responsiveness. As stated by one mother: In the early weeks after resuming sex, the baby herself did not intrude on our relations, but my exhaustion and discomfort did. T h e tenderness from the episiotomy lasted a good deal longer than six weeks, and this surprised me. More importantly, my total absorption in the baby and mothering drastically cut my interest and desire for sex.”’
Some couples of small breastfeeding babies report that once lovemaking begins, the baby rouses and begins to cry. O n e puzzled father“’ suggested that the reason for this mysterious response w a . the baby’s innate sense of survival. If sexual relations resulted in pregnancy, the breastmilk and, quite possibly nurturing, would be diminished. It is possible that a n infant could pick u p olfactory sensory cues from the milk ejection that frequently occurs during lovemaking or it may be yet another phenomenon of human behavior not yet explained by simple stimulus-and-response theories.
Feelings Toward the Infant As individuals we accept the notion that love leads to sex but ignore the corollary-sex leads to love. T h e sensual feelings the mother experiences during breastfeeding, if they are accepted as a natural, gratifying maternal experience, strengthen the feeling of tenderness a n d commitment to her baby. A number of ~ t u d i e s ~ ’ . ~h’a’v e reveal e d t h a t mothers who are breastfeeding tend to interact with their infants with different behaviors from bottlefeeding mothers. In one study“’ breastfeeding mothers, observed while feeding their babies at specific intervals in the first ten days after birth, were noted to touch their infants more when feeding was not taking place, feed for longer periods of t i m e with resultant increased hol di ng, c u d d l e a n d rock th e ir babies more, and sleep with their infants more often than bottle feeders. Members of the helping professions have, in recent years, become aware of the importance of maternal -i nfant bonding. T h r o u g h a 111
deepened psychosocial relationship a n d fulfillment of physiological needs, bonding is intensified into a kind of symbiosis between the nursing mother a n d infant. T h e strength of that bond is demonstrated when a b r u p t weaning must take place. T h e baby may cry for days a n d completely refuse t h e bottle. T h e mother, too, grieves, a n d for years afterwards can harbor feelings of resentment a n d sometimes hatred if she later realizes the weaning was not necessary after all.
terning of perinatal behavior, Childbearing: Its Social and Psychological Aspects. Edited by SA Richardson. Baltimore, Williams & Wilkins, 1967, p 223 5. Perez A, et al.: First ovulation after childbirth: the effect of breastfeeding. Am J Obstet Gynecol 114:1041-
Conclusion
8.
Sexual behavior takes a variety of forms. Some feelings are arbitrarily accepted as cultural norms, a n d others are considered deviant. Sexual feelings d u r i n g t h e breastfeeding cycle c a n a n d should be viewed by nurses o r any member of the health care team as a natural a n d import a n t i n t e g r a l m a t e r n a l response which has both pleasure a n d pur-
Po= References I. Pryor K: Nursing Your Baby. New York, Harper & Row, 1975, p 12 2. Newton N: Breast feeding. Psychology Today. June 1968, p 34 3. Kluckhohn C: Some aspects of Navaho infancy and early childhood. Psychoanal Soc Sc 1947, pp 37-86 4. Mead M, Newton N: Cultural pat-
1047, 1972 6. Green R: H u m a n Sexuality: A 7.
9.
10.
Health Practitioner’s Text. Baltimore, Williams & Wilkins, 1975 American Academy of Pediatrics: breast feeding: A commentary in celebration of the international year of the child, 1979. Pediatrics 62:4 October 1978 Newton N: Maternal Emotions. New York, Paul B. Hueber, Inc, 1955, p 62 Deutsch H: T h e psychology of women. Vol 2, Motherhood. New York, Grune & Stratton, 1945, p 294 “HOW’SYour Sex Life?” Special issue on sexuality, MS, November, 1976
I I. Masters W, Johnson V: Human Sexual Response. Boston, Little & Brown, 1966, pp 144, 162 12. Robinson J, Short R: Changes in breast sensitivity at puberty, during the menstrual cycle and parturition. Br Med J, 1977, p 1198 13. Kenny JA: Sexuality of the pregnant and breastfeeding mother. Arch Sex Behav 2:215-229, 1973 14. Ford C, Beach F: Patterns of Sexual Behavior. New York, Harper & Row, 1950, p 218 15. Bing E, Colman L: Making Love During Pregnancy. New York, Bantam Books, 1977, p 148
16. Krebs R: Interruptus. Psychology Today 3(8):33, January 1970 17. Thoman EB, et al.: Neonate-mother
interaction during breastfeeding. Dev Psycho1 6 110-1 18, 1972 18. Newton N, et al.: Psychological and behavioral correlates of mother’s choice of postpartum nearness to infant, The Family: 4th Int. Cong. Psychosom. Obstet. Cynecol. Tel Aviv, Karger, Basle, pp 389-393 19. Bernal J, Richards P Effect of bottle and breast feeding on infant development. J Psychosom Res 14:247, 1975 Address for correspondence: Jan Riordan, RN, Health Care Outreach, University of Kansas School of MedicineWichita, 1001 N. Minneapolis, Wichita, KS 67214. Jan Riordan is coordinator of the Mobile Inservice Education Program of the Universi(y of Kansas Health Care Outreach which develops continuing education programs for nurses in rural areas. A graduate of Wichita State Univers i p ( M N ) , she has had experience in hospilal and school nursing. Ms. Riordan cunenlly serves as Regional Profissional Liaison Administrator of La Lcchc League, International. Emib Rapp recentIy developed a comprehensive palien1 teaching program on breas(/ceding at Maricopa Counb General Hospital in Phoenix. While living in South America, she organized several La Lcchc League groups in Argentina and Brazil. Ms. Rapp is active in the Professional Liaison Department of Arizona La Lcchc Lcaguc.
The Tenth Annual Meeting of the Great P l e h Organization for Per& natal Heguh Care will be held );lay 18-20,1880, at Radisaoil South Hotel, Bloomington, Minnesota. “Year of the Family” ir the meeting’s theme,and there will be a total of ten hours of lecture6 and pn#lantations. CEUa applied for. For further information contact Virainia Riltenour, Box 50, 420 Delaware St. SE, Minneapolis, MN 5M55, (612) 373-5710.
112
March/April 1980JOCN Nursing
By examining sexualio in breasrJeeding as a reinforcement to ensure the continuip of the human species 0s well as promoting spacing between pregnancies, the aulhors review cross-cultural perspectives, physiologv, and research on this topic. Individual responses from breaslfccding women are also reported to enlarge the nurse’s understanding o$a dimension of human behavior not usualb acknowledged.
Human biology and life patterns are constantly in cyclic progression. We sleep, wake, experience changes in body temperature, blood sugar, and blood pressure in a synchrony of predictable rhythms. These cycles and rhythms, in their certain inevitability, have purpose for our life functioning. We can say also that in feminine reproductive function there are five cycles: ovarian, intercourse, pregnancy, childbirth, and lactation.’ Each of these has purpose a n d brings pleasure if experienced at an optimal level of function for the individual. The objective of this article is to explore the hypothesis that one of these, breastfeeding/lactation, is a sexually pleasurable process for the mother in addition to providing nourishment for her infant. Included in this hypothesis is the assumption that the very survival of Homo sapiens has been dependent on these sensual reinforcements of breastfeeding. If it were not so, man would have joined the dinosaurs in extinction long ago.’ That sexual pleasure should occupy the minds of nursing mothers may come not only as a novel, but also as a shocking, idea. Yet, in perusal of the many paintings of nursing dyads that abound in collections March/April I98OJOCN Nursing
Oogo-03I 1 /80/03 19-0losf0100
of great art, we may note a mood of introspection and a faint, bemused expression of pleasure o n t h e mother’s face, indicating that we may have been “looking but not seeing.” As a corollary, we will explore the notion that these energies being channeled into the breastfeeding experience are shunted away from other forms of sexual expression such as coitus and that this, coupled with the suppression of the ovarian cycle, is nature’s effort to prolong spacing between pregnancies, thus helping to ensure nourishment and nurturing for the infant for a longer period of time.
Cultural Perspectives Because cultural attitudes are intimately associated with the expression of feminine biological functions, sensual enjoyment during breastfeeding must be examined from a cross-cultural perspective. Attitudes toward breastfeeding and sensuality show considerable variation among different cultures, being developed in some, muted in others. T h e Navahos, for instance, have highly developed sexual innuendos. K l u c k h o h n ’ observed t h a t boy babies were observed to have erotic interchanges with their mothers with
penile erection during breastfeeding. In contrast, women of Alor in the Oceanic, “do not speak of the erotic pleasures of nursing.”’ In counseling lactating women in a midwestern community, the author has found the last statement to be descriptive of attitudes in this area and, from participation in national seminars on breastfeeding, the dominant attitude in the American culture. If specific sensual feelings are ever discussed, it is usually with hesitation, embarrassment, and in privacy. Under these conditions, one mother stated, “My breast, and especially my nipples, are more sensitive in sex now that I’ve nursed two babies t h a n before. Somewhere along the way, I learned that sucking felt good.” In many primitive cultures, concerns about sensual feelings are preempted by the expectation that lactation inhibits ovulation, offering a n a t u r a l s p a c i n g between pregnancies. Despite the considerable controversy on this subject, repeated studies in unrestricted breastfeeding, i.e., feedings that proceed without rules that restrict sucking and typically occur 8- 12 times per day, show t h a t ovulation is delayed 6-22 months.’’ Several cultures feel so strongly about spacing children and t h e need for recuperation, that 109
coitus is strictly prohibited throughout the lactation period. Our own cultural denial of sensua l i t y during breastfeeding is revealed in the almost total absence of reference to it in the growing body of sex literature. As a n example, Richard Green, the male author of two major books on sexuality, limits his discussion of sexuality during the postpartum period to: “Sexual interest in women will probably be low in the immediate post partum period. T h e return of sexual interest in coitus is variable.”” Recognition of sensuality during breast feeding is not broached in any of the major textbooks on sexuality; an astounding myopia in the light of current data that approximately 50% of all women presently breast feed their babies.’ Indeed, most research and observations are derived from the single male biological function: ejaculation through intercourse or masturbation. Is this glaring omission the result of ignorance or is it the threat to males that the feminine sexual cycles are so rich and varied?
Women’s Feelings About Sensuality A considerable body of objective evidence suggests that maternal attitudes are related to breastfeeding behavior and sensuality as a whole. Newton” reports that aversion to breastfeeding appears to be related to dissatisfaction with the woman’s lot in life, length of labor, desire for intercourse, smaller size of families, and the actual amount of milk secreted during lactation. Deutsch states: Personally I am convinced that by far the greatest part of nursing difficulties are psychogenic. . . that in the nursing period the psychic umbilical cord connects the mother’s breast and the child’s mouth and that it runs through the arena of the conflict between egoistic tendencies and the altruistic forces of motherhood.’
Another factor has been the emphasis which some members of the women’s movement have given to liberation from maternal roles. These individuals fear that a recognition of the nonorgasmic aspects of female sexuality would be counter110
productive, leading to a return of the “motherhood myth” which domesticates women and limits their potential outside the home. Instead, orgasmic liberation, rather than the fight for women’s rights to give birth and breastfeed free of medical (and mainly male) interference and cultural pressures, has received the most emphasis.“’
Erotic Stimulation T h e close relationship between sensual feelings and suckling at the nipple is real enough. T h e nipple is well supplied with nerve endings and their stimulation by the nursing baby causes uterine contractions which, in t h e early postpartum weeks, helps involution of the uterus to its pre-pregnancy state. This interrelationship between the breast and the lower reproductive tract has been r e p e a t e d l y d e m o n s t r a t e d . Oxytocin, the hormone released during the ejection of milk or let-down, causes the uterine muscle fibers to contract rhythmically during breastfeeding. During the early feedings following birth, these contractions are usually felt as strong and painful cramps; l a t e r t h e painless contractions continue for about 20 minUtes after the feeding. Conversely, failure to experience uterine contractions indicates inadequate letdown which leads to engorgement which in turn leads to inadequate milk supply. Further evidence of this relationship is the effect of lower reproductive tract stimulation on milk flow. For example, vaginal stimulation is a recognized way for dairy farmers to induce milk flow in cows, and there are reports from human mothers of dripping or spurting of milk during heightened sexual response and orgasm. Other similarities of physiologic responses between sexual arousal and breastfeeding are the erection of the nipples with marked vascular changes, lengthening of the nipple, rhythmic stroking of the nipple during sucking, and extensive skin-toskin contact. Masters and Johnson found that this stimulation was reported by some women to have brought them to plateau levels of sexual response and, on several occasions, to orgasm.” Since birth is the
beginning of a long intimate relationship between a mother and her baby, is it unreasonable to expect it to be physiologically pleasurable like the sexual pleasures at the beginning of a long, intimate, and committed relationship with a mate? Despite this tenable notion, guilt is a common response to these feelings. Six of the 24 women studied by Masters and Johnson expressed guilt feelings over their sexual arousal. Just as some religious beliefs prescribe procreation as the ruison d’etre for the enjoyment of intercourse, nourishment is often regarded as the sole purpose of the breastfeeding act. T h e exact nature of the sensual feelings during nursing should be differentiated from coital arousal. Interviews with lactating women indicate that sustained erotic stimulation and/or orgasm is not the usual experience. Although the nipple itself is very sensitive” during feedings, much stimulation falls upon the areola which is comparatively insensitive to touch. Intense anticipatory erotic sensations are unlike the tranquil and peaceful sensual feelings described by mothers following the let-down of the milk. In response to a question regarding erotic feelings during feeding, one mother stated: If I don’t have the baby positioned right, and he starts gumming the nipple, sure, I begin to feel just like I do when my husband stimulates my breasts when we make love. But it gets in the way, this feeling, as here I am sitting and waiting to let down my milk and I’m getting more and more tense. I just shift the baby around until he’s got the entire areola and then we have a good feeding.
Unfortunately, some women who experience sensual feelings during nursing feel guilty to the point that they voluntarily wean their babies early and refuse to nurse future children. T h e question now arises: Why don’t some mothers feel sensual during nursing even though they have nursed several months? Are they intimidated by social expectations and not admitting it, or in fact, is nonsensuality just another response in March/April 1980JOCN Nursing
the wide range of possible feelings? On e such mother confided, “Although I nursed, I never felt that it was in any way sexual for me. It brought me no particular pleasure, but on the other hand, it wasn’t unpleasant either.” O n e possible explanation is that a woman whose breast a n d nipples are not normally erogenous zones is not likely to become erotically stimulated by the suckling of her infant.
Breastfeeding and Sexual Relations Receptiveness of t h e n u r s i n g mo th e r t o coitus a n d sexual expression with her mate is reported in the literature to be increased or diminished, depending on the source. Masters a n d Johnson found that breastfeeding women, as a group, reported a prompt return of sexuality a n d a return to higher levels of sexuality than bottlefeeding mothers. I ’ However these responses were not measured physiologically. I n another study,” three-fourths of t he s a m p l e d m o t h e r s r epor t ed t h a t breastfeeding had little effect on their sexual lives. O u r own experience a n d that of others in counseling mothers seems to indicate that sexual desire, at least on the part of the nursing mother, lessens considerably during lactation. Describing her feelings during this period, a mother reported: When you are home and you touch, hold, hug, and nurse all day, you’re not so interested in it when your husband walks through the door. But then his day has been all talk all d a y a n d n o touch a n d he’s ready. It creates a problem.
Observations of mating behavior of animals supports this theory. T h e majority of lower mammalian females do not normally become receptive until their young are weaned.”’ Nervous stimuli evoked by suckling appear to prevent the secretion of gonadotropic hormones from the pituitary a n d as a result, the ovaries d o not produce the sex hormones necessary to mating behavior. Female mice, for example, nurse their young for ab o ut three weeks a n d then estrous cycles and sexual receptivity reappear. O n the other hand, this mother gave a different view: March/April I98OJOCN N u r r q
To me sex is best of all during the later breastfeeding period because I feel physically better than at any other time, and there is n o need for c o n t r a c e p t i v e s b e c a u s e for me, breastfeeding is a 100% effective contraceptive for a b o u t a year. There’s something about nursing a little baby that gives you a n “all’s right with the world” feeling. I feel so happy a n d loving toward my whole family as well as the baby. Sex just seems to be a nice, natural expression of this good feeling.
This apparent wide variance of sexual responsiveness may be due to the following reasons. First, because of the importance of the Masters a n d Johnson research as a whole, any dat a derived from their studies is frequently referred to, a n d is accepted, as valid. However, in the Masters a n d Johnson study cited above, only 24 reports by lactating women were studied, hardly a population sample for any statistical significance-a point which the authors themselves clearly make in the text. Also, the halo effect of participation in o n e segment of m uch wider sex studies cannot be discounted. O n the other hand, when physiological changes were measured on the nursing breast during sexual tension from general stimulation, n o consistent size increases were noted in the Masters a n d Johnson studies.” Second, the Ford and Beach theory, that the clear-cut relationship between fertility a n d sexual responsiveness in lower mammalian species is less well defined in subhuman primates a n d is completely obliterated in the human female, may account for the heightened sexual response reported by some women. It could be t h a t w o m e n w h o choose to breastfeed, as a group, possess a greater interest in coitus throughout their entire reproductive cycle than women who, because they are uncomfortable with their total sexuality, prefer to bottle feed. Certainly the exhaustion a n d anxiety of t h e new m ot her with a n added work load, interrupted sleep, a n d concern about her ability to car e for her baby would understandably cause a drain on her li-
bido and sexual responsiveness. As stated by one mother: In the early weeks after resuming sex, the baby herself did not intrude on our relations, but my exhaustion and discomfort did. T h e tenderness from the episiotomy lasted a good deal longer than six weeks, and this surprised me. More importantly, my total absorption in the baby and mothering drastically cut my interest and desire for sex.”’
Some couples of small breastfeeding babies report that once lovemaking begins, the baby rouses and begins to cry. O n e puzzled father“’ suggested that the reason for this mysterious response w a . the baby’s innate sense of survival. If sexual relations resulted in pregnancy, the breastmilk and, quite possibly nurturing, would be diminished. It is possible that a n infant could pick u p olfactory sensory cues from the milk ejection that frequently occurs during lovemaking or it may be yet another phenomenon of human behavior not yet explained by simple stimulus-and-response theories.
Feelings Toward the Infant As individuals we accept the notion that love leads to sex but ignore the corollary-sex leads to love. T h e sensual feelings the mother experiences during breastfeeding, if they are accepted as a natural, gratifying maternal experience, strengthen the feeling of tenderness a n d commitment to her baby. A number of ~ t u d i e s ~ ’ . ~h’a’v e reveal e d t h a t mothers who are breastfeeding tend to interact with their infants with different behaviors from bottlefeeding mothers. In one study“’ breastfeeding mothers, observed while feeding their babies at specific intervals in the first ten days after birth, were noted to touch their infants more when feeding was not taking place, feed for longer periods of t i m e with resultant increased hol di ng, c u d d l e a n d rock th e ir babies more, and sleep with their infants more often than bottle feeders. Members of the helping professions have, in recent years, become aware of the importance of maternal -i nfant bonding. T h r o u g h a 111
deepened psychosocial relationship a n d fulfillment of physiological needs, bonding is intensified into a kind of symbiosis between the nursing mother a n d infant. T h e strength of that bond is demonstrated when a b r u p t weaning must take place. T h e baby may cry for days a n d completely refuse t h e bottle. T h e mother, too, grieves, a n d for years afterwards can harbor feelings of resentment a n d sometimes hatred if she later realizes the weaning was not necessary after all.
terning of perinatal behavior, Childbearing: Its Social and Psychological Aspects. Edited by SA Richardson. Baltimore, Williams & Wilkins, 1967, p 223 5. Perez A, et al.: First ovulation after childbirth: the effect of breastfeeding. Am J Obstet Gynecol 114:1041-
Conclusion
8.
Sexual behavior takes a variety of forms. Some feelings are arbitrarily accepted as cultural norms, a n d others are considered deviant. Sexual feelings d u r i n g t h e breastfeeding cycle c a n a n d should be viewed by nurses o r any member of the health care team as a natural a n d import a n t i n t e g r a l m a t e r n a l response which has both pleasure a n d pur-
Po= References I. Pryor K: Nursing Your Baby. New York, Harper & Row, 1975, p 12 2. Newton N: Breast feeding. Psychology Today. June 1968, p 34 3. Kluckhohn C: Some aspects of Navaho infancy and early childhood. Psychoanal Soc Sc 1947, pp 37-86 4. Mead M, Newton N: Cultural pat-
1047, 1972 6. Green R: H u m a n Sexuality: A 7.
9.
10.
Health Practitioner’s Text. Baltimore, Williams & Wilkins, 1975 American Academy of Pediatrics: breast feeding: A commentary in celebration of the international year of the child, 1979. Pediatrics 62:4 October 1978 Newton N: Maternal Emotions. New York, Paul B. Hueber, Inc, 1955, p 62 Deutsch H: T h e psychology of women. Vol 2, Motherhood. New York, Grune & Stratton, 1945, p 294 “HOW’SYour Sex Life?” Special issue on sexuality, MS, November, 1976
I I. Masters W, Johnson V: Human Sexual Response. Boston, Little & Brown, 1966, pp 144, 162 12. Robinson J, Short R: Changes in breast sensitivity at puberty, during the menstrual cycle and parturition. Br Med J, 1977, p 1198 13. Kenny JA: Sexuality of the pregnant and breastfeeding mother. Arch Sex Behav 2:215-229, 1973 14. Ford C, Beach F: Patterns of Sexual Behavior. New York, Harper & Row, 1950, p 218 15. Bing E, Colman L: Making Love During Pregnancy. New York, Bantam Books, 1977, p 148
16. Krebs R: Interruptus. Psychology Today 3(8):33, January 1970 17. Thoman EB, et al.: Neonate-mother
interaction during breastfeeding. Dev Psycho1 6 110-1 18, 1972 18. Newton N, et al.: Psychological and behavioral correlates of mother’s choice of postpartum nearness to infant, The Family: 4th Int. Cong. Psychosom. Obstet. Cynecol. Tel Aviv, Karger, Basle, pp 389-393 19. Bernal J, Richards P Effect of bottle and breast feeding on infant development. J Psychosom Res 14:247, 1975 Address for correspondence: Jan Riordan, RN, Health Care Outreach, University of Kansas School of MedicineWichita, 1001 N. Minneapolis, Wichita, KS 67214. Jan Riordan is coordinator of the Mobile Inservice Education Program of the Universi(y of Kansas Health Care Outreach which develops continuing education programs for nurses in rural areas. A graduate of Wichita State Univers i p ( M N ) , she has had experience in hospilal and school nursing. Ms. Riordan cunenlly serves as Regional Profissional Liaison Administrator of La Lcchc League, International. Emib Rapp recentIy developed a comprehensive palien1 teaching program on breas(/ceding at Maricopa Counb General Hospital in Phoenix. While living in South America, she organized several La Lcchc League groups in Argentina and Brazil. Ms. Rapp is active in the Professional Liaison Department of Arizona La Lcchc Lcaguc.
The Tenth Annual Meeting of the Great P l e h Organization for Per& natal Heguh Care will be held );lay 18-20,1880, at Radisaoil South Hotel, Bloomington, Minnesota. “Year of the Family” ir the meeting’s theme,and there will be a total of ten hours of lecture6 and pn#lantations. CEUa applied for. For further information contact Virainia Riltenour, Box 50, 420 Delaware St. SE, Minneapolis, MN 5M55, (612) 373-5710.
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March/April 1980JOCN Nursing