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How to Choose a Wet Nurse / The Frequency of Breastfeeding

June 27, 2011

“What You Should Pay Attention to When Hiring a Wet Nurse” (雇奶妈应当怎么样注意 gu naima yingdang zenmeyang zhuyi)
By: Bao Qiexu (鲍洯胥)
Popular Medical Journal (通俗医事月刊 tongsu yishi yuekan)
#1 October 1919, 33-35

“Frequency of Breastfeeding” (哺乳的次数 buru de cishu)
By: Bao Qiexu (鲍洯胥)
Popular Medical Journal (通俗医事月刊 tongsu yishi yuekan)
#1 October 1919, page 36

Bao Qiexu wrote two articles about breastfeeding and wet nurses in the introductory issue of Popular Medical Journal from October 1919. Before I start to discuss these two articles, I should mention the opening letter of the issue. The editor writes that everyone is always discussing the strength or weakness of the nation and those who study the positions of countries in the world each have their own views about how countries become strong. One of these views is that equal knowledge of health/hygiene (卫生 weisheng) is a symbol of a country’s strength. It says something to me that a publication titled Popular Medical Journal is placing the propagation of knowledge about medicine under the rubric of national strength and progress. Basically, educating the (literate and one can assume wealthy) populace about health and hygiene is not just about improving their health but it is directly tied to the strength of the nation. This only reaffirms so much of what I have already said on this blog about the underlying nationalism behind much of the discussion about breastfeeding and breast binding.

At the very start of the article “How to Choose a Wet Nurse,” Bao emphasizes that the most critical part of rearing a child is nutrition and nothing is better for a child than human milk. The milk substitutes (代乳散 dairusan and 炼乳 lianru) that are sold in cities simply can not compare to human milk because one is natural (自然 ziran) and the other is man-made (人工 rengong). Bao continues and says that if for some reason a woman’s breast milk is insufficient or “because of other reasons,” then one must hire a wet nurse. However, great attention should be paid to hiring a wet nurse because there is a great connection between the wet nurse and the child. Once again the issue of “natural” versus “man-made” comes up again, with Bao firmly asserting that natural nutrition is the best. Is this a reaction to industrialization? The overwhelming number of those milk substitute products were made by foreign companies (you can see an example of an advertisement for one of these products in my post here) and they were marketed to the new urban classes. In some ways, they became a symbol of modernity, so why are they seen as negative?

The first thing to pay attention to when choosing a wet nurse is the wet nurse’s health. Bao repeatedly remarks that the connection between the wet nurse and the child is very strong. If the wet nurse has tuberculosis, syphilis, gonorrhea, scabies, or leprosy etc. etc. then she should not be hired because these kinds of illnesses are contagious and can be passed to the child through breast milk. Bao refers to a story he remembers from two years ago in which a woman who was afraid of breastfeeding – why she was afraid of breastfeeding is never mentioned – hired a wet nurse without considering the health of the wet nurse and her child developed a syphilis rash and became sickly and thin. In this article and others like it that I have read, there is a very palpable anxiety about infectious diseases. Is this because of an increase in disease or an increased knowledge about disease?

I am particularly fascinated by the way that wet nurses are discussed in this article. Although never explicitly mentioned in this article, the wet nurse occupied a very tenuous position within the household. In the Imperial period, a wet nurse gained unofficial entry to a family through her deep connection to the child she reared. While she lacked any official position, this role could give her power and influence over the child and open opportunities for her own children. Of course this position could create some anxiety in the family but did this anxiety about a wet nurse’s place within the family exist in the Republican period? During this period, there is a rhetorical dismantling of the large patriarchal family which is frequently described as the bastion of all that is backward/”traditional” in China. This “large family” (大家庭) is replaced with a new “small family” (小家庭) that has the young and modern husband/father and a love marriage at its center. Was there a place for wet nurses in this new nuclear family? From this article and others, it seems the answer is no.

Equally interesting is the connection between class and disease in this article. It is assumed that the kind of women who would be hired as wet nurses, presumably lower class women, would carry diseases. Of the diseases Bao mentions, he particularly harps on syphilis and mentions it repeatedly throughout his article. Syphilis is spread through sexual contact and in assuming that lower class women are more afflicted with the disease, there is an implicit sexualization of lower class women. This fits in with what I have seen regarding the exposure of breasts in public. Lower class women were associated with large breasts and after having a child, it was totally accepted that they could breast feed in public.

The second thing to pay attention to is “breast milk secretion” (乳汁分泌 ruzhifenbi) which is broken into three subsections: the shape of the breast, the wet nurse’s age, and when the wet nurse last gave birth. The first section is fairly straight forward: when choosing a wet nurse, you (wife/mother? husband/father?) should choose a woman with hemisphere shaped or “round hammer shaped” breasts that are slightly drooping. The skin should be tight and have a luster to it. The second item is also fairly straight forward. Once a prospective wet nurse’s breasts were examined, you should carefully investigate her age. The best age is 20-30 years old and ideally she will have given birth a few times already. The last section deals with when the wet nurse herself has last given birth. Typically, a woman chooses a wet nurse who has recently given birth but Bao suggests that the best is to choose a wet nurse who gave birth 1/2 month to 1 month before the mother. This way, you can know how much milk she produces and if she has any diseases because if she is contagious, her own child will be ill. Furthermore, you should pay attention to her living conditions and her diet. If she lives in a dirty place or if she eats “simple and coarse” food, she should not be hired because these things could affect your child. What woman who needed to earn extra money as a wet nurse could fulfill all of these requirements?Thus, it seems that hiring a wet nurse should be the last resort. The only people who could probably fulfill all of these requirements are the wealthy women who would have access to this magazine.

The second article, “Frequency of Breastfeeding,” begins with Bao acknowledging that it is hard to create a standard for how often a child should be breastfed because children’s ages and physiques can vary greatly. He writes that it is very important to pay attention to breastfeeding in the two days following the child’s birth. One (Bao doesn’t indicate birth mother or wet nurse here) should wait until twenty-four hours after the birth to do the first feeding and after that, the child should be breastfed 8-10 times until the third day, when it should start being fed 6-7 times per day. He notes that it is also very important to set a regular time for feeding and suggests that feeding every two hours is best. After two religious services (礼拜 li bai) – I do not know how much time that is – the child should be fed 5-6 times a day at an interval of 3 or 3 1/2 hours per feeding. At night, the feeding intervals can be slightly longer because it is best to develop the habit of not breastfeeding at night. Bao never lists why breastfeeding at night is bad but it might have something to do with digestion? He also instructs women to pay attention to how much breast milk is used during each feeding and whether or not the child’s physique (体格 ti ge) is good. When the mother’s breast milk – this is the first time mother is used – is plentiful, each feeding should last 10-15 minutes. If you feed a child too much, it won’t be able to digest all of the milk and it will slowly develop gastrointestinal illnesses. If you do not feed a child enough, its development (发育 fayu) will be hindered. Thus, you must pay attention to how much you breastfeed and consider the child health’s carefully.

It isn’t until halfway through this article that the mother of the child is mentioned by title, even though it is her time and energy at stake here more than the child’s. Of course Bao believes that the mother’s milk is the best milk but the strain that breastfeeding puts on her body is never discussed. Fellow Fulbrigher Lua Wilkinson is researching contemporary infant nutrtion and when I read her blog (linked above) I remember just how much time it takes for a woman to breastfeed. In Bao’s article, he says that after two religious festivals a child should be fed 5-6 times a day for 10-15 minutes per feeding. Perhaps this can be seen as a sign of the changes taking place with women’s labor during this period. Previously, women were tasked with their own form of labor which included managing the household and its finances, creating cloth and clothing, and raising children. With changes in this labor – for example clothing began to be mass-produced and purchased in stores – or an erasure of the very existence of this labor, wealthy women had more time (or were expected to have more time) to breastfeed and care for their children?

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