Mama Knows Breast: A review

Andi Silverman presents a breezy, conversation-with-girlfriends style in her new book Mama Knows Breast: A Beginner's Guide to Breastfeeding. Meant to be a basic handbook rather than an oracle (Silverman provides a list of those at the end of her book), Mama Knows Breast covers the essentials of breastfeeding a baby: pros and cons, "operating instructions," etiquette, and spousal involvement, among others.

It's important to read the book cover to cover, since Silverman either omits or glosses over some details in the opening chapters but covers them later on. Still, even as a handbook, I found it to be not quite informational enough, especially to a first-timer. For example:

• Silverman recommends healing sore nipples with breastmilk, but doesn't say why (the antibodies in the milk aid healing).
• While she advises that thrush can be cured with antifungals, she doesn't discuss the natural remedies (including probiotics) that many women feel are more conducive to healing (especially if mother and/or baby are taking antibiotics).
• A mention of the milk-supply-enhancing effects of dark beer doesn't take into account research that shows it is the prolactin level, not the actual supply, that increases with alcohol intake.
• Nursing pillows are never mentioned (they can help support a smaller-than-average infant, as well as an inexperienced mother; I depended on mine with my first, but hardly needed it with my second).
• Neither are growth spurts, which can be stressful for a mother who doesn't know why her baby suddenly refuses to be put down!

A discussion about the history of formula is good, but does not discuss social/class attitudes toward breast- and formula-feeding during this century - a critical omission, since many of our grandmothers felt that breastfeeding was something "only poor people" did. Even if our mothers disagree, the lack of support from either or both generations can persist, leading a mother to give up sooner than she might have liked.

Some details outright concerned me. "No one's handing out a martyr medal," Silverman tells the reader after she advises not to suffer in silence, but this is not what keeps many women from asking for help. Instead, help is either not there (if a new mother lacks supportive family and friends) or it's available, but conflicts (differences in opinion among care providers, such as the pediatrician and the obstetrician).

In my own experience, confused about how to handle my older son's dietary sensitivities and afraid that my care providers would advise a switch to formula, I ended up calling my local La Leche League leader. Many women are not so lucky, and Silverman doesn't account for this. (Neither does she account for soy allergies, which can affect many babies who are sensitive to milk protein, or spicy foods, which can trigger reflux in reflux-prone babies.)

Likewise, a frank mention of sexual arousal while breastfeeding is not given adequate attention. Specifically, given the anxiety in our culture about sex and children, Silverman could have devoted a few extra sentences to the reason why this happens: the hormone oxytocin, which flows in abundance during both sex and nursing. It happens that way to promote bonding between partners - yes, nursing is a partnership - which is crucial to a mother and the newborn she doesn't yet know.

The book does have its strengths. Relationships are given some weight in Mama Knows Breast, which was nice to see. A father's role gets a good discussion, as does co-sleeping, which receives a realistic balance as to safety vs. efficacy. Some of the relationship advice is a bit too glib - "Use erotica" may not be helpful to people who simply aren't turned on by it, and "Keep communicating" doesn't help a couple who have had hundreds of conversations interrupted - but by the same token, sometimes the simplest solutions just don't occur to sleep-deprived, lifestyle-shocked couples.

The "From the Mouths of Moms" segments, following a format in use by other childcare experts, are good (notwithstanding the mother who advocated breast pumping while driving - "If people can talk on their cell phones while driving, why can't I pump?" - actually, many states and cities now ban cell phone use while driving); it's always helpful to see how other moms have handled a trying situation.

Silverman also spends considerable time discussing relactation for adopted babies, as well as using milk from milk banks. Her section on nursing etiquette is wonderful in its detail, including comebacks for nosey critics. Likewise her kick in the pants about comparing oneself to celebrities who have personal trainers, chefs, and nannies that most of us can't afford.

Silverman's best advice is in her closing paragraphs. "Wean yourself of all your preconceived notions about breastfeeding.... In some ways, that's the beauty of this whole Mama thing. You get to make it up as you go along." All in all, Mama Knows Breast is a good start, but in spite of its encouraging tone, may not be all a newly nursing mother needs as she starts - or continues - a nursing relationship.