by Jill Lepore
The American “epidemic of lactation failure” depended, too, on the evolving design of baby bottles: so sleek, so clean, so scientific, so modern. The industrial-era rise of processed, bottled, canned, and packaged food was so precipitous that some historians refer to it as the Food Revolution. That age of machines that had locomotives chugging across the continent brought food from farms to factories, where it was canned and bottled and packaged. Cow’s milk went from farms to factories, too. And, soon, you could pour that cow’s milk that you could buy in a can into bottles that babies could suck. The first U.S. patent for a baby bottle was issued in 1841; the device, shaped like a breast, was to be worn over a mother’s chest, as a prosthetic. But, year by year, bottles came to look less like breasts and more like silos. The familiar cylindrical bottle, called the “Stork Nurser,” dates from the 1910s and is inextricably tied to the rise of the stork myth: babies come from storks; milk comes from the milkman. Perversely, Freud’s insistence that infants experience suckling as sexual pleasure proved a boon to stork-style repression, too: mothers eager to keep infantile incestuous desire at arm’s length propped their babies in high chairs and handed them bottles.22 Arm’s length, or further: patents for “bottle holders,” taken out beginning in the 1890s, allowed for bottles to be propped on tables, hung from strings suspended from over cribs, and hooked to the tops of prams, not unlike the way water bottles are clasped to the sides of a hamster’s cage.
Meanwhile, more and more women were giving birth in hospitals. This meant that, for the first time in human history, infants born prematurely or very small were given a chance of survival—if only there were enough milk and a way to get it out of a woman’s breast and into the belly of a baby too tiny to suck.
In 1910, a Boston doctor, Fritz Talbot, spent three days searching for a wet nurse. He failed. Exasperated, he established a placement service, the Boston Wet Nurse Directory. Across town, Frances Parkman Denny, caring for a sick baby, asked a neighbor to hand-express her milk for him. When the infant improved after drinking just three ounces, Denny, a bacteriologist, became convinced of the “bactericidal power” of human milk. The year after Talbot started his Wet Nurse Directory, Denny opened the first human milk bank in the United States, collecting milk from donors using a breast pump whose design was inspired by bovine milking machines.23
The modern breast pump can be traced to two late-nineteenth-century developments: the birth of neonatology—the word “neonatal” was coined in the 1890s—and the industrialization of dairy farming. (Milking machines are cited in breast pump patents; at the level of basic engineering, Medela’s Pump In Style wasn’t very different from Dairymaster’s Swiftflo.) Denny’s plan worked better than Talbot’s: families who needed and could afford human milk did not generally like having poor women living with them as in-house wet nurses; they preferred having their milk delivered in bottles. Talbot stopped placing wet nurses and instead distributed their milk; he renamed his agency the Directory of Mother’s Milk.24
Once milk banks replaced wet nurses, human milk came to be treated, more and more, as a medicine, something to be prescribed and researched, tested and measured, in flasks and beakers.25 Denny’s bottled, epidemiological model prevailed. What happened next is a twice-told tale. Treating milk as a medicine promoted synthetic milk. Laboratory-made formulas improved; aggressive marketing of processed infant food—not just bottles of formula but jars of mush and all manner of needless pap—grew to something between badgering and downright coercion. The infant food industry grew. By the middle of the twentieth century, the majority of American women fed their babies formula. Babies sucked bottles, not breasts. But, all this while, Erasmus Darwin’s rhapsodic view of the milky breast endured. “With his small head pillowed against your breast and your milk warming his insides, your baby knows a special closeness to you,” advised The Womanly Art of Breastfeeding, first published by La Leche League in 1958. “He is gaining a firm foundation in an important area of life—he is learning about love.”26
In the 1960s, nursing as a mammalian mommy-baby love-in began a comeback, at least among wealthier and whiter women. The history of food appears to follow this rule: when the rich eat white bread and buy formula, the poor eat brown bread and breast-feed; then they swap. Meanwhile, the more scientists studied milk, the less good formula looked. The same science that had brought formula brought a panic about formula. To encourage women to return to breast-feeding not long after they had been persuaded to abandon it (having been told by manufacturers that formula was more scientific), doctors had to talk about human milk as a medicine—a better medicine than formula.
This took some time to become a major public health issue. But in 1997, the American Academy of Pediatrics issued a policy statement on breast-feeding and the use of human milk, declaring human milk “species-specific” and recommending it as the exclusive food for the first six months of a baby’s life, to be followed by a mixed diet of solid foods and human milk until at least the end of the first year. In that statement and in a subsequent revision, the AAP cited research linking breast-feeding with reduced incidence and severity of, among other things, bacterial meningitis, diarrhea, respiratory tract infection, ear infection, urinary tract infection, sudden infant death syndrome, diabetes mellitus, lymphoma, leukemia, Hodgkin’s disease, obesity, and asthma. The benefits of breast-feeding, the report insisted, are unrivaled, and breast-feeding rates in the United States were abysmally low; the combination made for a public health emergency. In 1990, the Department of Health and Human Services announced a goal of increasing the proportion of mothers who breast-feed their babies “at initiation” (i.e., when they leave the hospital) from a 1998 baseline of 64 percent to a 2010 target of 75 percent; until the age of six months, from 29 percent to 50 percent; and at one year, from 16 percent to 25 percent.
Attempts to improve initiation rates met with spotty success. The Rush University Medical Center, in Chicago, which established a peer-counseling program called the Mother’s Milk Club, achieved an initiation rate of 95 percent; nationally, the rate hovered around 70 percent. More difficult was raising the rates at six and twelve months. The CDC, which issued an annual Breastfeeding Report Card, reported that in 2010 the rate of exclusive breast-feeding at six months was only 13 percent (although the rate of some breast-feeding at six months had risen to 43 percent); only the initiation rate had been met.27
One reason so many women stopped breast-feeding after a matter of weeks was that, in the United States, more than half of the mothers of infants under six months old were leaving home to go to work—a change that began with industralization and the age of machines, which separated home from work. The 1993 Family and Medical Leave Act guaranteed only twelve weeks of (unpaid) maternity leave, and, in marked contrast to established practice in other industrial nations, neither the government nor the typical employer offered much more. The 2010 Health Care Act required employers to “provide reasonable break time for an employee to express breast milk for her nursing child for 1 year after the child’s birth each time such employee has need to express the milk” and “a place, other than a bathroom, that is shielded from view and free from intrusion from co-workers and the public, which may be used by an employee to express breast milk”; but it was not clear how that would work out, as a matter of enforcement.28 To follow doctor’s orders, a woman who returned to work twelve weeks after childbirth had to find a way to feed her baby her own milk for another nine months. The nation suffered, in short, from a Human Milk Gap.
There were three ways to bridge the gap: longer maternity leaves, on-site infant child care, and pumps. Much effort was spent on the cheap way out: option 3. At the turn of the century, Medela distributed pumps in ninety countries, but its biggest market, by far, was the United States, where maternity leaves were so short, unpaid, and unsanctioned that many women, blue-, pink-, and white-collar alike, returned to work just weeks after giving birth. (Breasts supply milk in response to demand; if a woman is unable to
put her baby to her breast regularly, she will stop producing milk. Expressing not only provides milk to be stored for times when she is away, it also makes it possible for a working woman to keep nursing her baby at night and on the weekends.) In 1998, Congress had authorized states to use food stamp funds granted to the USDA’s Women, Infants, and Children nutrition program to buy breast pumps for eligible mothers.29 Studies reported that breast-feeding rates rose with maternal age, education, and income. Medela offered a Corporate Lactation Program, which included free advice for employers seeking to reduce absenteeism and health insurance costs by establishing “Mother’s Rooms.” These would be equipped, ideally, with super-duper electric pumps because “breastpumps with double-pumping options save time and can even help increase a mother’s milk supply.” The loss of productivity, Medela promised, would be slight: “If each employee uses safe, effective, autocycling breastpumps, each visit to the Mother’s Room should last no longer than 10 to 15 minutes.”30
Even more intensive was the energy directed toward legislative reform. By 2008, forty-seven states had passed laws about breast-feeding. Most had to do with option 3. Must companies supply employees with refrigerators to store milk expressed during the workday, else it spoil? Twenty-one states, along with Puerto Rico and the District of Columbia, required employers to make a “reasonable effort” to accommodate nursing mothers and their bottled milk. These laws, however, were generally toothless: the National Zoo’s compliance consisted of putting a chair and a curtain in a ladies’ room. (The posher the employer, the plusher the pump station. Baristas at Starbucks had to barricade themselves in loos intended for customers, while traders at Goldman Sachs could go online to reserve half-hour slots in designated lactation rooms.)31 In 2007, Oregon became the first state to pass a law requiring companies with more than twenty-five employees to provide “non-bathroom” lactation rooms. (A national media campaign asked, reasonably enough, if you wouldn’t make your kid a sandwich in a public restroom, why would you expect a woman to express her baby’s milk in one?)32 In California, the comedian Will Ferrell toted his wife’s pump to the Golden Globe ceremony, though whether the Beverly Hilton has a dedicated, non-bathroom lactation room was a matter of hospitality and not of law. Did nursing in public violate state obscenity laws? In most places, no. In 2009, Virginia and Maryland joined twenty-three other states in exempting women who expose their breasts while suckling infants from indecency laws. Whether pumping in public is obscene had not yet been tested—and, honestly, who would want to?—but, what with all these lactation rooms, that seemed off the table.33
More rules were under consideration. Could a woman or her employer get a tax break for producing or storing milk, some kind of dairy subsidy? Maryland exempted breast pumps from its sales tax, but Congress was deadlocked over the Breastfeeding Promotion Act, introduced in 2007 and again in 2009. The goals of the bill were four: to add the word “lactation” to the Civil Rights Act of 1964; to define lactation as “the feeding of a child directly from the breast or the expressing of milk from the breast”; to provide a tax credit of up to $10,000 per year for companies that provide pumps to their employees; and to set and enforce performance standards and safety rules for pumps.34 A better title for the proposed legislation might have been the Breast Pump Promotion Act. Some breast-feeding advocates argued that human milk fell under Article 25 of the U.N.’s 1948 Universal Declaration of Human Rights: “Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care.”35 Expressing and drinking human milk, these people insisted, are human rights, but baby food had, by now, become a partisan trigger issue. In 2010, the IRS decided that flexible spending health care funds could not be used to buy breast pumps, the Times reporting that the health care consultant Roy Ramthun (who worked at the Treasury Department) said tax officials were worried about allowing breaks for something that could be classified as food.36 In 2011, Michelle Obama’s support for breast pump tax breaks inspired Tea Party congresswoman and presidential aspirant Michele Bachmann to rejoin, “To think that government has to go out and buy my breast pump— You want to talk about nanny state, I think we just got a new definition.”37 When people talk about machines, everything seems new, even when it’s old.
Breast pumps aren’t sinister; they can be useful, even indispensable and, in some cases, lifesaving. But a thing doesn’t have to be underhanded to feel cold-blooded. How different is a “boob cube” at the Capitol from a Hatchery? To be hooked up to a breast pump is to be chained to the age of the machine. Non-bathroom lactation rooms are so shockingly paltry a substitute for maternity leave, you might think that the Second Gilded Age’s craze for pumps— especially the government’s pressing them on poor women while giving tax breaks to big businesses—would have been met with skepticism by more people than Tea Partiers. Not so. The growth of the breast pump industry was not only not questioned by women’s groups but had, in fact, been urged by them.38 The National Organization for Women wanted more pumps at work; NOW president Kim Gandy complained, “Only one-third of mega-corporations provide a safe and private location for women to pump breastmilk for their babies.”39 What ever happened to asking for more than a closet?
The difference between employer-sponsored lactation programs and flesh-and-blood family life is stark. Breast-feeding involves cradling and cuddling your baby; pumping involves cupping plastic shields on your breasts and watching your nipples squirt milk down a tube. Rhode Island’s Physicians’ Committee for Breastfeeding gave an annual award for the most Breastfeeding-Friendly Workplace, a merit measured, in the main, by the comforts provided in pumping rooms; for instance, the Gold Medal winner’s “soothing room” was equipped with “a sink, a lock on the door, and literature.” It appeared no longer within the realm of the imaginable that, instead of running water and a stack of magazines, “breastfeeding-friendly” could mean making it possible for women and their babies to be together. Some lactation rooms even went so far as to make a point of banning actual infants and toddlers, lest mothers smuggle them in for a quick nip. At the University of Minnesota, staff members with keys could pump their milk at the “Expression Connection,” but the sign on the door bore this warning: “This room is not intended for mothers who need a space to nurse their babies.” When Playtex debuted a breast pump called the Embrace, no one bothered to scream, or even to murmur, that something you plug into a wall socket is a far cry from a whisper and a kiss.
Is milk medicine? Is suckling love? Of all questions about life and death, taxonomical questions are some of the trickiest. At the end of the twentieth century and the beginning of the twenty-first, breast pumps were handy; they were also a handy way to avoid a politically unpalatable topic about the artificiality of modern life: Is it the mother or her milk that matters more to her baby? Meanwhile, mamma ex machina: Medela offered a breakthrough model with “2-Phase Expression.” Phase one “simulates the baby’s initial rapid suckling to initiate faster milk flow”; phase two “simulates the baby’s slower, deeper suckling for maximum milk flow in less time.” These newest machines, the company promised, “work less like a pump and more like a baby.”40 More like a baby? Holy cow. We are become our own wet nurses.
[CHAPTER 3]
The Children’s Room
Anne Carroll Moore was born long ago but not so far away, in Limerick, Maine, in 1871. She had a horse named Pocahontas, a father who read to her from Aesop’s Fables, and a grandmother with no small fondness for Uncle Tom’s Cabin. Annie, whose taste ran to Little Women, was a reader and a runt. Her seven older brothers called her Shrimp. In 1895, when she was twenty-four, she moved to New York, where she more or less invented the children’s library.1
At the time, you had to be fourteen, and a boy, to get into New York’s Astor Library, which opened in 1854, the same year as the Boston Public Library, the country’s first publicly funded city library, where you had to be sixteen. Even if
you got inside, the librarians would shush you, carping all the while about how the “young fry” read nothing but “the trashy”: Scott, Cooper, and Dickens. (One century’s garbage being, as ever, another century’s Great Books.) Samuel Tilden, who, before his death, in 1886, left his $2.4 million fortune to “establish and maintain a free library and reading room in the city of New York,” nearly changed his mind when he found out that 90 percent of the books charged out of the BPL were fiction. Meanwhile, libraries were popping up in American cities and towns like crocuses at first melt. Between 1881 and 1917, Andrew Carnegie underwrote the construction of more than sixteen hundred public libraries in the United States, buildings from which children were routinely turned away on the grounds that they were noisy, messy, and careless but chiefly because they needed to be protected from books, especially novels, which would corrupt their morals. Something had to be done. In 1894, at the annual meeting of the American Library Association, established in 1876, the Milwaukee Public Library’s Lutie Stearns read a “Report on the Reading of the Young.” Stearns wondered, What if age limits were lifted? What if libraries were to set aside special books for children, shelved in separate rooms for children, “staffed by attendants who liked children”?2