Breastfeeding woman or lactating object? A critical philosophical discussion on the influence of Cartesian dualism on breastfeeding in the neonatal intensive care unit

Abstract

Aim This discursive paper aims to bring to the foreground the ongoing influence of Cartesian dualism and other important contextual complexities on breastfeeding in the neonatal intensive care unit (NICU). Background Breastfeeding is widely supported as the optimal form of nutrition for the first 6 months of life and beyond. Amidst a myriad of contextual factors, current breastfeeding rates are below globally targeted goals. For premature and/or critically ill infants, the importance of receiving breast milk is often encouraged based on its immunological and nutritive benefits as opposed to the entirety of the breastfeeding interaction, underscoring the influence of dualism in the NICU. Design The impact of Cartesian dualism and other sociocultural underpinnings of breastfeeding focused within the NICU environment are illustrated through a critical, philosophical discussion. Methods Relevant historical context is provided followed by an overview of the realities of contemporary breastfeeding. These are presented as a frame of reference for the NICU breastfeeding experiences currently encountered by many mothers of preterm and critically ill neonates, further illustrated using a clinical exemplar as well as the author's own observations from neonatal nursing practice. Relevance to clinical practice Shifting away from a dualistic approach requires rethinking breastfeeding support interactions between NICU nurses and mothers. To address the disembodied and often mechanistic approach to care inherent in the dominant Western medical model, a relational approach to breastfeeding support in the NICU is suggested and discussed. Conclusion Future research from a more critical lens is needed to examine the complex dynamics involved when nurses and mothers are negotiating decisions and processes related to infant feeding. In focusing on the relational dimensions of the breastfeeding experience, nurses can resist the dualistic influence and dominant discourses impacting infant feeding and motherhood in the 21st century.

A qualitative study on the breastfeeding experience of mothers of preterm infants in the first 12 months after birth

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Applying Feminist Poststructuralism as a Framework for Exploring Infant Feeding Interactions in the Neonatal Intensive Care Unit

“…Not unlike infant feeding discourses related to term/healthy infants, it is evident in much of the NICU literature that breast(chest) milk is considered the 'optimal' form of nutrition in comparison to formula. As argued in a recent critical discussion piece, the act of breast(chest)feeding and/or producing breast(chest) milk is given new meaning within the NICU setting (van Wijlen, 2019). In this context, it goes beyond a life-sustaining form of nourishment, frequently presented by NICU care providers as a life-saving intervention based on its immunological and nutritive benefits (van Wijlen, 2019).…”

“…As argued in a recent critical discussion piece, the act of breast(chest)feeding and/or producing breast(chest) milk is given new meaning within the NICU setting (van Wijlen, 2019). In this context, it goes beyond a life-sustaining form of nourishment, frequently presented by NICU care providers as a life-saving intervention based on its immunological and nutritive benefits (van Wijlen, 2019). This inevitably constructs the scientific/medical discourse in a different way and imposes high moral stakes related to infant feedingrelated decisions for parents of infants in the NICU without necessarily considering the contexts and complexities of the parental 'choice' being made.…”

“…Care provided to childbearing and childrearing families in our Canadian health care system is predominantly oriented through a mechanised medical model wherein the influence of patriarchal hegemony is evident. Consequently, the current climate of care is one that is largely focused on quantifiable outcomes and productivity, measured against Western standards, norms and ideals (Dykes, 2005;van Wijlen, 2019). As a result, the experience of providing and receiving care, particularly amongst marginalised populations, is largely decontextualised.…”

A qualitative cross-cultural analysis of NICU care culture and infant feeding in Finland and the U.S.

“…Many NICUs still have policies that postpone any breastfeeding attempts until a certain gestational age; however, this may cause the infant to miss the developmental window to begin eating from breast [19, 20]. Furthermore, the benefits of direct breastfeeding to the mother should not be overlooked, especially as related to establishing a relational bond with the infant [21–23].…”