Breastfeeding in Times of Emergency, Stress, Distress, and Crisis
This is a translation of this Hebrew article.
There are times when crises arise that go beyond the personal or family circle, such as regional or even national emergencies, natural disasters, and war. Breastfeeding women can find themselves among those affected by the crisis. Feeling stress, tension, fear, anxiety, confusion, helplessness, uncertainty, frustration, and more is natural. These feelings may be common among the entire population. If a mother usually has support systems, she may find it difficult to rely on these familiar networks when the distress is on a broader scale.
During such periods, a mother may have questions about the continuation of breastfeeding., including those about changes in routines, or the crisis. It is important to understand that if there was no problem with breastfeeding and milk production before the crisis, the state of emergency is not likely to affect milk production and continued breastfeeding.
Amount of Milk
Human milk is created on demand and the frequency and amount of milk that is removed from the breast (the daily frequency of breastfeeding sessions, pumping, or expression) are the primary factors in establishing a good milk supply. Changes in routine during emergency situations that result in reduced frequency of breastfeeding and/or pumping during a day, may cause some mothers to experience changes in the amount of milk.
Concern about milk production may lead mothers to consider adding formula. Giving formula instead of breastfeeding lowers the frequency of milk removal from the breast and thus may affect the amount of milk available over time. Skipping breastfeeding sessions may cause a decrease in milk production. If milk production has fallen due to reduced frequency of nursing, women can restore or increase their milk supply by nursing more frequently, or adding pumping or milk expression sessions. Mothers should notice an increase in their milk supply within a few days.
Effect of Stress on Milk Letdown
When stressed, some women may experience a slight delay in their milk letdown, causing delays in the flow of milk. Mothers may describe their infants as more irritable and fussier than usual and have difficulty latching. The delay in latching can influence oxytocin release. Oxytocin is the hormone responsible for letdown, and its production can be affected by stress. In a crisis situation, the milk is still produced in the breast, but its release may be delayed, causing further fussiness in the baby. Finding ways to relax, even in a difficult situation, may remedy this difficulty. Moments of relaxation at the beginning or during a breastfeeding session can help facilitate a quicker milk letdown.
“Relax!”
We know that it is not easy for women experiencing distress to relax. When the situation is stressful, it’s difficult to “press a button” and relax. At the same time, in different situations related to milk production (and perhaps, also in general), relaxation can help. It’s clear that in tough situations, relaxation can seem impossible to achieve, but breastfeeding does not require complete relaxation, rather just brief moments of slowing down.
There are different methods to achieve a more relaxed state. Relaxation techniques can help in many different situations and are even more important during a crisis.
Many mothers have found the following ways to relax and reduce stress: exercises to promote relaxation and increase mindfulness such as meditation, guided imagery, controlled breathing, yoga, various types of physical work, and touch. Using different degrees of touch, ranging from gentle touch through deep massage, at the choice of the mother and baby, can be very useful.
Skin-to skin contact with your baby can help regulate his/her temperature, breathing and heart rate, boost your milk supply, stimulate your baby’s urge to feed, increase your bond with the baby and release oxytocin which both increases your milk supply and helps you bond or continue your bond with your baby. Many mothers have found that wearing the baby is a good way to do this while keeping hands free.
We have gathered some tips for brief relaxation from our experience:
turning off social media
watching light-hearted television programs
viewing favorite photographs
caressing the infant
taking deep and slow breaths while counting
light meditation
guided imagery
imagining the milk flowing
drinking a cold or hot drink
stepping outside or on the balcony for a few minutes
smelling scented essential oils or plants
(For information in Hebrew on anti-anxiety medications that are compatible with breastfeeding see here)
Flavor of Milk
There is a myth that the flavor of milk turns bitter during periods of stress. It is important to understand two issues. First, no research has shown that milk is bitter during periods of stress. Second, human milk is a dynamic living tissue. The flavor of milk constantly changes. As such, infants manage with a range of flavors of milk.
Quality of Milk
During times of stress, women may not eat and drink as they would normally. It is important to take care of yourself and your strength, while also maintaining the quantity and quality of your milk so that you can continue to breastfeed as usual. It is a myth that when a mother is in distress, milk quality will be poor or harmful. The quality of human milk is not influenced by mood, depression, stress, or fear. As always, milk is highly nutritious and tailored to your baby’s unique needs, including the individual customization of antibodies, variable proportion of fat, and more. There is no such thing as “sad milk.” It is important to understand that emotions are part of life and that mothers may experience a wide range of feelings. It is critical that the infant feels connected to his/her mother, senses stability in their world, and benefits from bonding through the breastfeeding relationship, regardless of mood.
From the Infant’s Perspective
Many mothers report breastfeeding issues related to changes in their routines. These concerns may relate to the quantity of milk or breastfeeding success. When routine changes, all people are affected. Adults and children feel a range of emotions. The amount of time mothers spend with their infants changes which may alter mothers’ breastfeeding patterns. Crisis situations may not end quickly and over time, infants continue to grow and change, which also influences breastfeeding behaviors.
If the infant’s breastfeeding behavior changes, it does not automatically indicate a problem but rather a change in the conditions. In periods of great change and tough emotional times, breastfeeding allows mothers to respond to the specific needs of their infants, initiate more contact, closeness. Breastfeeding will comfort, regulate, calm, and encourage the mother and her infant to remain connected. When in a crisis, mothers may want to reconsider changes that were planned in advance such as changing bedrooms and weaning from night nursing, and postpone them until things are more settled.
Is it worth continuing to breastfeed in times of crisis?
Water and food supply may be compromised for the entire population, food distribution systems and food supplies may also be damaged. Breastfeeding and human milk, which are always available, do not spoil and are always accessible, can be an especially important resource in such times.
Breastfeeding is nutrition that is always clean, healthy, individually tailored, and accessible at any given moment, independent of any external factors. Human milk gives protection against diseases and infections that may be more common during times of emergency. Breastfeeding may provide an emotional anchor, a set routine, touch, security, warmth, love, and comfort, which can facilitate moments of tranquility and relaxation during the day. . Many mothers say that breastfeeding comforts them and helps them maintain their strength during these times.
For information in Hebrew on continuing breastfeeding during difficult times, please follow the link: https://www.lllisrael.org.il/post/keepon
Breastfeeding During Times of Mourning
In situations of loss and mourning, there is no restriction on continuing to breastfeed. The decision is personal for each woman. As mentioned above, human milk does not “spoil” or become unsuitable for infants and toddlers. It is permissible to breastfeed and to be in pain, to grieve and to feel a wide range of emotions. Breastfeeding can help mothers who are dealing with loss and grief by the very act of focusing on the infant and his/her needs. From a hormonal perspective, breastfeeding can facilitate emotional and physical regulation. It is important that a woman who breastfeeds during a period of mourning be aware of drinking, eating, and resting. She should pay attention, as much as possible, to the basic needs of her body.
Sometimes, breastfeeding and meeting the infant’s needs can serve as a physical and emotional anchor for the mother in this situation while at other times, it may be appropriate to terminate breastfeeding. This is a decision that must be made by each individual woman, based on her circumstances.
For information on weaning, please follow the link:
In English:
Personal Support
For any issues, we recommend speaking with a La Leche Leader. Please follow the link: https://www.lllisrael.org.il/
English speaking support is available through
English speaking La Leche Israel WhatsApp: https://chat.whatsapp.com/Do2hrkzhnQtKQ8tMQq06iN
English Israeli FB group: https://m.facebook.com/groups/LLLIsraelSupport/?ref=share&mibextid=I6gGtw
Related articles: Breastfeeding during times of emergency:
In Hebrew:https://www.lllisrael.org.il/breastfeeding-info/categories/emergency Skin-to-skin: https://www.lllisrael.org.il/post/skin2skin Picture series of breastfeeding during times of stress: https://www.lllisrael.org.il/post/stress
In English, Arabic, and other languages:
A position statement recently published by the Academy for Breastfeeding Medicine contains useful information for healthcare professionals, relief personnel, and families:Bartick, M., Zimmerman, D. R., Sulaiman, Z., Taweel, A. E., AlHreasy, F., Barska, L., Fadieieva, A., Massry, S., Dahlquist, N., Mansovsky, M., & Gribble, K. (2024). Academy of Breastfeeding Medicine Position Statement: Breastfeeding in Emergencies. Breastfeeding Medicine, 19(9), 666–682. https://doi.org/10.1089/bfm.2024.84219.bess
This article was originally published on the La Leche League Israel website during “Swords of Iron” War, October 2023, by Vered Leb and Efrat Feldman, and translated to English by Dr. Ilana Chertok.