It has always been a quandary of mine, why some women succeed in achieving their feeding goals and others don’t. At what point does it become ‘you didn’t try hard enough’ to ‘you did your best’?
Is it the amount of pain that was endured? Is it the amount of obstacles hurdled over? Is it the amount of time spent trying? Is it when it’s worse than an experience you had, or someone you know had? Why don’t we like giving women permission to stop?
There are a great deal of women who don’t encounter any breastfeeding issues, despite there being a tongue-tie, or less then perfect latch. There are also a very large proportion of women that do suffer pain whilst trying to get things established. There are some women that seem to endure huge difficulties setting the benchmark spectacularly high for everyone else and there are other women who simply cannot continue another second with, what some may view as, minor breastfeeding issues.
A preliminary study published in April 2014, suggests that pain threshold and our differing abilities to deal with pain is partly genetic. The study involving 2,700 participants demonstrated an increased prevalence of particular genes depending on whether they were classified as having a high pain threshold or a low pain tolerance.
These are apparently new findings and will obviously need to be studied in much more detail, but does it gives a possible answer to why some women are able to endure pain better that others?
There are also factors that affect pain threshold. I certainly notice in my patients, those that are tired, stressed or anxious have a much lower tolerance of pain than those that are calm and well-slept. I would hazard a guess that the vast majority of new mothers are tired, stressed and anxious. However, on top of this, some people pain catastrophize.
“Pain catastrophizing affects how individuals experience pain. People who catastrophize tend to do three things; they ruminate about their pain (“I can´t stop thinking about how much it hurts”), they magnify their pain (“I´m afraid that something serious might happen”), and they feel helpless to manage their pain (“There is nothing I can do to reduce the intensity of my pain”). This apparently can increase the experience of pain, both physically and emotionally.
Initially, research suggested that one could be desensitised to pain by continual exposure to a particular pain source, whereas it is now thought that the more a pain is experienced, the less tolerable it becomes. I can certainly vouch for the latter, preferring death over enduring another contraction.
I have often seen breastfeeding as being likened to ‘running a marathon’ suggesting it can seem like a long, hard task which will require endurance and some tolerance to pain. I’m certainly not a marathon runner, in fact sports in general fill me with horror so I never really liked this analogy. But it also got me thinking about athletes and their ability to endure. Mental toughness is a term used in sports psychology to describe the ability to overcome difficulties mentally, physically and emotionally. Whereas pain tolerance and management has root in biology, mental toughness seems to be purely learnt and sports psychologists are often used to improve an athlete’s performance.
Despite being for sportspersons, I took this questionnaire to discover what I already knew – I’m not that mentally tough. I feel very demotivated if I am not succeeding, i.e, if the picture in my head doesn’t marry up with the reality. I once took about twenty five minutes to jump off a small ledge into the sea, holding my step-dad’s hand. I didn’t feel great when I finally did it, just self loathing that it took me so long. I get very despondent and almost depressed if I am criticised, especially if I’ve tried my hardest and certainly don’t take well to failing. I have the voice of Marlin from Finding Nemo in my head, “you think you can do these things but you just can’t <<inserts own name>>”
When I look at self esteem from a breastfeeding point of view, it feels like it has a great deal to do with the outcome. When it’s not going well, it is very easy to catastrophize in those dark, painful, tired moments – “I’m no good at this,” “I’ll never get it,” “I’m not a good mother.” Stress levels are increased thus decreasing the tolerance of pain especially when it’s sending every nipple nerve ending to hell and back. Not only will it obstruct any mental toughness previously thought to have been possessed but it will also diminish any positive self image one may have fantasised about when picturing motherhood.
One study examining postpartum depressive symptoms with 738 women showed that the mothers with low self esteem were 39 times more likely to have high depressive symptoms one to two months after birth. In fact there are a number of studies that agree low self esteem is a contributory factor to postnatal depression and it is cited as a risk factor on Mind’s website.
With all this in mind, it has made me think about my original quandary, my daughter and building her self esteem. Not to guarantee that she’ll be successful at breastfeeding, but to be successful at maintaining her integrity and positive self image, regardless of her feeding outcome. To enable her to endure any difficulties she may come against and hold her head high if it doesn’t work out. To not be flattened by the weight of postnatal depression that is the reality for so many women (including her mother). To know her value. To never have to justify herself. To love herself regardless and to say a big ‘fuck you’ to anyone who tries to tell her otherwise.