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Chapter 7 87 When physicians do not allow mothers to breastfeed immediately after giving birth, when hospitals house newborns in nurseries apart from their mothers, and when nurses feed breastfed newborns formula without their mothers’ explicit permission, it becomes obvious that the medicalization of birth and infant feeding impede breastfeeding. What is less apparent is how the historical development of the two medical specialties that interact most with mothers and their babies, pediatrics and obstetrics, has shaped attitudes toward breastfeeding. Since the late nineteenth century, mothers have sought infant feeding advice from pediatricians and obstetricians. Ironically, women began doing this in earnest just as the breastfeeding expertise of these specialists waned. The first generation of American pediatricians and obstetricians shared a difficult reality: no job security. Although today everyone acknowledges that pediatrics and obstetrics are vital specialties, nineteenth- and early twentiethcentury Americans dismissed both fields. When seeking a physician for a child, parents judged doctors’ competence by their ability to heal adults. Treating only children seemed de facto evidence of incompetence. Medical professionals and laypeople alike consequently scorned pediatricians as “baby doctors.” Obstetricians faced similar attitudes. Most general practitioners attended births as an occasional service for patients and thus tended to view obstetrics as a trivial sideline. Mothers had a similar view. As obstetrician Joseph DeLee lamented in 1903, he had difficulty attracting patients because women believed that childbirth was an event requiring little more specialized medical attention and treatment than breathing.1 Pediatrics, Obstetrics, and Shrinking Maternal Authority Jacqueline H. Wolf This disdain for pediatrics and obstetrics would shape attitudes toward breastfeeding. As pediatricians and obstetricians attempted to attract patients, breastfeeding became an inadvertent victim of their efforts. Historians of pediatrics have recognized this phenomenon because change in infant feeding practices prompted public acceptance of pediatrics.2 When historians of birth practices have studied maternal authority, however, they have understandably focused on the birthing chamber and ignored obstetricians’ connection to the decrease in breastfeeding rates.3 This chapter links the history of both pediatrics and obstetrics to mothers’ move from breastfeeding to feeding with formula. Nineteenth-Century Pediatrics Medical schools discouraged interest in children’s diseases in the nineteenth century. When Isaac Abt, for example, wanted to study pediatrics after graduating from Chicago Medical College in 1891, professors told him his interest would harm his medical practice, marginalizing him among colleagues and parents. In contrast, Europeans had long recognized the unique medical needs of children, and so Abt traveled to Europe to study pediatrics. When he returned to Chicago in 1894 to set up a practice, however, he found his mentors had been right. Mothers would not bring their children to him.4 Not until pediatricians helped mitigate the nation’s high infant mortality rate, a public health problem they often termed “the feeding question,” did they enjoy significant respect and clientele. The feeding question was deceptively simple. If a baby had no access to human milk, what food could the child safely consume? This was a new problem for medicine. Before the late nineteenth century, infant feeding was the mother’s domain, and mothers breastfed for as long as their babies needed their milk. In the rare instance that breastfeeding was not possible, families hired a wet nurse or, particularly when a mother died in childbirth, relied on a sympathetic lactating neighbor to feed the baby. If a wet nurse was unaffordable or a neighbor unavailable, the baby died. While death for want of human milk was acknowledged as tragic, no one deemed it a misfortune that medicine could remedy. This fatalism toward infant death ended in the last quarter of the nineteenth century. As the public became aware of the link between health and the establishment of water and sewer systems, municipalities sought ways to measure the success of this expensive infrastructure. Reasoning that babies were uniquely sensitive to changes in the environment, health officials began using the infant mortality rate to assess the effectiveness of public works projects.5 88 Jacqueline H. Wolf This benefited American babies, 13 percent of whom died before their first birthday in 1900. Infant mortality statistics demonstrated what pediatricians had long suspected: half of all babies who died were dying of diarrhea. The discovery prompted a change in thinking. Perhaps babies did not have a “natural weakness and sensibility” predisposing them to death. If diarrhea was their primary killer, maybe something was wrong with their food.6 Changing Infant Feeding Practices Pediatricians were at the forefront...


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