Informed choice to breastfeed/formula feed

[hunkermunker]

Were you given the opportunity to make an informed choice?

At what point in your antenatal/postnatal care would you have liked the most information about bfeeding?

Who should have given you that information? How should it be presented so that you are best able to take it on board?

For instance, would a lecture-style antenatal class work best? A one-to-one with a midwife/HV? Seeing new mums?

And how do you feel about being given benefits/risks information about bfing/ffing? Is giving women a "benefits of bfing/risks of ffing" info sheet in pregnancy something that should be done? Or do you run the risk of "making women feel guilty"?

[Jacanne]

I know on other forums that I've been on there has been a lot of threads about the risks of ffing and they have resulted in some very heated discussions. Those who have not managed to BF tend to feel guilty and very miserable and those that never intended to feel very defensive. However, despite this many women genuinely think that FF is as good or merely 2nd best to BF so maybe those facts should be more out there regardless.

I did (do) BF successfully so am perhaps not your target audience but I would think that talking to BF mums would have been the most helpful thing for me - they're the ones I have learnt the most from on-line and IRL. Also I think that a one to one with HV/midwife would only be beneficial if they're the right kind of MW/HV - there are a lot out there who don't really seem to believe in BF - perhaps a BFC would be better?

[TwinklemEGGan]

Some really good questions there Hunker. I'll try to answer them (with apologies for the essay that follows...)

Yes at the beginning I was able to make an informed choice and I chose to breastfeed - no question. Having said that I had a lot of information about the benefits of breastfeeding. I can't say that I was given any information specifically about the downside of formula feeding, though I knew it already to a point. My choice was based on bf being the obvious, natural thing to do. Someone from a different background might not have come to that conclusion.

Later on, as you know, I didn't really have a choice if DS wasn't going to starve.

Your second question is a difficult one. During the antenatal period I think women are generally more focussed on getting through the pregnancy and giving birth to a healthy baby - I know I was. I had an NHS antenatal class on breastfeeding. In hindsight this did state that breastfeeding can be very hard - at the time though I didn't really take it on board.

I think it would have been really useful to have a one to one about breastfeeding soon after the birth - even just a ten minute chat with some leaflets and helpline numbers would have been useful, just to know that it's OK to find it hard and to ask for help.

I found out during a visit for a postnatal check that the hospital had a breastfeeding room. No one told me this while I was there after the birth(for 3 days). To be able to sit and breastfeed with other new mums and a dedicated midwife/counsellor on hand to help us would have been terrific.

I think the booking-in pack could include a lot more information about breastfeeding, notwithstanding what I said above.

The antenatal class I attended wasn't that useful because it was rather chaotic. I am not sure at all that a lecture-style is an appropriate method as breastfeeding is a skill that can only be learned by observation and practice. I wonder if there are any mums who would be prepared to breastfeed their baby in front of mums-to-be - that would be much more useful than videos and posters.

The last set of questions is really tricky as I can see it both ways. There are perhaps three groups of women to consider:

a) those who choose to breastfeed but find it really difficult and have to supplement with formula for whatever reason, including those who cannot breastfeed at all for medical reasons

b) those who choose not to breastfeed because they don't want to

c) those who genuinely believe that formula is just as good as or better than breastmilk and therefore actively choose to formula feed

Speaking from a personal point of view I do think there are dangers in giving women too much information about the risks of formula feeding. Yes, knowing the risks can certainly focus the mind when one is struggling to establish breastfeeding and feeling tempted to pack it in. However, a new mother is often in an extremely vulnerable physical and mental state and may not be thinking clearly. As I said, speaking personally, I was desperate to breastfeed and it wasn?t working out. I had read that formula fed babies have a higher risk of cot death. In my precarious postpartum mental state, I managed to convince myself that I was going to kill my baby because I was having to supplement him with formula. Knowing the risks certainly focussed my mind and helped me to keep breastfeeding to some extent until he was 4 months, but I went to emotional hell and back in the process. Was it worth it? Knowing the effect my emotional state had on my establishing relationship with DS I am not sure to be honest. And I only had mild PND, if at all.

However, if there really are women out there who think formula is just as good or even, God forbid, better than breastfeeding, then clearly something has to be done to address that. I personally wouldn?t worry too much about making women feel guilty for formula feeding if that is truly their choice from the outset. My view on that would be that if they feel guilty then the message is getting through. If they were completely happy with the decision they wouldn?t feel guilty. In that case, better to get the information at the outset so they can make an informed choice and not find out when it?s too late.

In the case of women who are forced into formula feeding against their initial wishes, for whatever reason, then the main guilt they feel comes from within. So the information per se, as long as it is delivered in a sensitive way, wouldn?t ?make? them feel guilty I don?t think. But there needs to be a balance struck between emphasising that breastfeeding is the optimal feeding method and that formula has its risks (which tbh I think the majority of women know), but avoiding dramatic claims of alleged links to terrible diseases etc. which could be incredibly upsetting to women who have no choice.

God that?s a mammoth post ? sorry!

[hunkermunker]

Thank you for your responses.

I really don't know quite the best way forward with it - it does seem that whatever you do wrt giving information, you'll make someone feel either guilty or upset that they weren't given the facts.

I think it's interesting about seeing new mums bfeeding being something that would help - one thing to be careful of here is something that Tiktok said that stuck in my mind - you can't always get a new mum to say "the right thing" - she might say "of course, I'm lucky, I love drinking water, so drinking the 18 pints a day you need to bfeed successfully is easy for me" when, of course, you don't need to drink more water than usual to bfeed - but to correct a new mum in the first flush of love with her baby and bf is like kicking a puppy.

TM, what you said about a one-on-one soon after the birth is a very good idea - perhaps some of the more pro-bf midwives/HCPs could do that. When you have midwives who say "I don't know why you're bothering with this bf nonsense, mine were all ffed and they're perfectly fine" it's not exactly helpful!

What a shame you didn't know there was a bf room at the hospital

It's hard to get the balance between "BF can be very hard" and "the benefits SO outweigh the risks, so it's worth sticking with it" - you don't want to put women who will find it straightforward off trying at all but you don't want to give the impression that if it doesn't work immediately, they're doing something wrong, because it can take time to click.

Will do some more thinking. I have had one idea, but I'll start another thread about that.

Thanks again - appreciate the time taken to write the posts. Haven't been online much lately (PC has gone wrong at home).

[MissGolightly]

I attended an NCT class and the way the teacher did it was very successful, I thought. We had a mixed-sex meeting with all the couples and were asked to "brainstorm" the advantages and disadvantages to bf/ff. Then the instructor corrected any myths and added a few extra points. It ended up very pro-breast but "naturally" so, iyswim, because we had come up with that slant ourselves. We got the facts but it didn't feel too much like we were being lectured.

Then we had a female-only class concentrating on the mechanics of bf and how best to get it started, using knitted dolls and illustrations. It might have been useful seeing a real mother bfing, but tbh I think until you do it yourself it's all theoretical anyway.

Post-birth I had difficulty getting my sleepy baby to latch on, and the support from the hospital was patchy (too many midwives all saying different things and then buggering off!) but they were very pro-bfing, I never felt pressured into giving formula.

[hunkermunker]

MissG, interesting re your brainstorm - glad that worked well for you. I think it can be v positive, but also if you had someone who was v vocal re ffeeding in your group, it might've not been as useful?

[WanderingTrolley]

I'm of the impression, having never done it, that bf can be a right pain to start with, but after the bumps get ironed out, it's well worth it.

And by 'a right pain' I mean non supportive hospital staff, ignorant health visitors, negative comments from friends and family, physical pain etc.

Realistic?

My above opinion wouldn't put me off it, btw.

[Pruni]

Message withdrawn

[rowan1971]

This is going to be quite opinionated, and possibly completely incorrect, but here goes: I think we have a big problem with regard to bf-ing and social class. I think a lot of working-class women (for want of a better term) are fed up with middle-class women telling them what's 'best' for their babies, and react strongly against it. They've seen their mums/sisters/mates ff-ing their babies, know that said babies usually grow up perfectly hale and hearty, and resent the restrictions (in terms of sheer time that the mother must spend feeding or expressing) that bf-ing implies. I think you could almost say that the overwhelming choice of working-class women to ff is culturally-led, and I'm not sure that yet more pressure from mws/hvs is the way to change their minds.

Having said that, I don't know what the way forward is. So this is probably completely unhelpful!

Can I just say that I'm an extended bf-er and read the Guardian daily.

[Pruni]

Message withdrawn

[calvemjoe]

At 9 weeks, when dd was feeding constantly, not gaining weight and it felt like she was sucking glass.

[rowan1971]

Oh well, that blows my theory.

Thanks a lot, Pruni.

Seriously, I think it has a lot to do with what your mum/mates/female relatives do. Which is not necessarily related to class, but in this country at the moment, it often is.

[shonaspurtle]

Hmm, to be honest bf rates were so dire in this country that most women of all classes were brought up to see ff as the norm.

A friend of mine is getting a lot of hassle from both her mother and mil because she is perservering with bf. They are really irritated by this bizarrely and are both resolutely middle class and well educated (and ff their children).

[mollymawk]

What I would have liked is not the info to enable me to choose which to do, but the info to enable me to bf when it seemed not to be working very well. Or some clue as to to what it might actually be like.

Before I had my ds1 I had seen hardly any real people actually bf-ing. The NCT info I got from my classes was, I must admit, not much cop (cartoons...).

Talking to real bf-ing mothers would have been so helpful. Just to get an idea (in full technicolor glory/horror) what it could be like.

[divastrop]

i havent read all the posts but i thought i'd offer my POV as a mother of 5 who has chosen to ff from birth the last 4 babies due to a dire experience with bf no.1.

when i was expecting ds1 back in 1997 i attended ante-natal classes etc and looking back the 'breast is best' message was very much forced down my throat,to the point where potential problems with bf were glossed over and ff wasnt mentioned atall.so when i gave birth after a horrendous labour during which i was drugged to the eyballs,i fell asleep as soon as i got to the ward,only to be told my baby had been given a bottle by the mw's as his blood sugar was low

this was followed by me attempting to bf a baby who wouldnt wake due to all the drugs,and being told i was having problems cos my boobs were too big and my nips too flat by a mw who smelt like gin.

after 5 miserable weeks of trying to bf i gave up,but i didnt tell my hv for ages cos i was so ashamed that i'd 'failed' at something which was meant to come naturally.i was also made to feel guilty by my xp.

when i had dd1 11 months later,i didnt decide to ff untill she was born,cos i held her in my arms and though'i just cant go through that again'.i was basically left to my own devices after that and the mw's ignored me and looked at me like i was scum every time i asked for a bottle.

i lived in a different area back then but had ds2,dd2 and dd3 where i live now,and during every pregnancy when i was asked how i intended to feed and replied 'formula',it was simply written on my notes and no more was said about it.i may have considered bf this time,even for a short while,but i didnt really think about it untill i overheard the mws at the hospital talking about another mum who wanted to hire a breast pump so she could feed her baby EBM from a bottle and i thought 'i could have done that if i'd know it were an option'.after all,i know breast milk is superior to formula,its just the method of feeding i have a problem with.

[yomellamoHelly]

Bf both my dss. Really struggled with ds1, though (difficult pregnancy and quite battered afterwards), and he was mixed-fed from 10 days. Never really considered any other way tbh so a list of benefits would not have influenced me.
Had a leaflet in last (NHS) antenatal class on how to bf which was quite good, but no pros/cons. Was in hosp 3 days after ds1 and the help I got was terrible. (We both struggled to get the hang of it. I'd naiively assumed it would be straight-forward as no-one had told me any different.) There were too many different midwives who I'd never met before and knew I wasn't going to see again after that shift sporadically assaulting my boobs and trying to force ds1's head and mouth into the right positions (according to how busy they were), all with different approaches (none of which seemed to help) who got me us both stressed out about it all which made situation worse. There was no-one I could talk to properly about it and the hv who I tried to talk to on day 10 just poo pooed my concerns (dh was sent out for bottles and formula that day). So bf counsellor the day after ds1 was born (night baby) would have really helped and then that person on the end of a phone in those first few weeks. Failing that a decent hv who actually knows her stuff. And a warning in the ante-natal classes that it takes a while.

[MissGolightly]

Hi Hunker, sorry only just seen your reply to my post about the brainstorm and the possibility that it might be dominated by one person's pov. I agree it could have been a problem but I think it's down to the way the instructor handles it.

The way our teacher did it was to divide us into small groups so in theory a very pro-ffer could have influenced one of the groups, but because we all came together for the final "write-up" the eventual document was almost inevitably balanced. Plus the main discussion was mediated by the instructor so she didn't allow any one pov to dominate and was very careful to debunk anti-bf myths.

And actually I think in a way it's better to let those anti-bf myths come up so that they can be addressed. Sometimes you don't just need the facts, you also need to know the falsehoods out there as people will inevitably spout them the minute you leave hospital. A lot of anti-bf myths did come up in the discussion but because they were addressed by the instructor I was able to counter people in RL when they said things like "a baby only benefits from breast milk for the first few days anyway you know" and "you should be giving him water in this hot weather". I would never have known this was bollocks without someone raising it in the group and the teacher specifically debunking it.

[hunkermunker]

Sounds very positive - needs a well-trained teacher to facilitate it, but I agree, the myths need to come up in order to be debunked.

[BizzyDint]

see we did the same sort of thing at my antenatal group. midwife ran local bf cafe so should have been top notch i'd have thought. however her way of debunking myths was just to say it's not true. no real explanation. same when she was explaining benefits of bf, no real explanation ie ... 'if you bf then your baby will NEVER be obese.' so group say 'oh really how come?' she says 'cos they just don't get fat like they do with formula..' errrrrr. ok some people need explanations pegged at their level of knowledge but for others they want to know the science, the real evidence etc.

also, she was crap when dealing with '..but what if i can't bf..' she basically said 'oh don't be so negative, women have been doing it for hundreds of years..and you can all come to my cafe anyway.'

[MissGolightly]

Yeah, I think basically whatever method you choose of informing people, the effectiveness basically comes down to how good the person behind it is. If the midwife/person running it doesn't know their stuff then you just end up not believing a word they say. Luckily the woman who did ours was fantastic - she could quote statistics, studies, outcomes, and she wasn't afraid to say when she didn't know something or when the evidence was inconclusive. Which was a good thing really because there were 2 medical doctors and 2 scientific phds in the group, so plenty of people who would have taken her up if her facts were dodgy.

She was also very good about not "over-selling" iykwim. Eg talking about how it was a good idea not to introduce a bottle too early in case of nipple confusion, someone said that they had heard it was possible for a bf baby to end up refusing to take a bottle at all. She was totally honest and said "yes, that can be a problem. You have to decide which is more important to you; the possibility of your baby refusing the breast, or the possibility of refusing the bottle." I think sometimes if an advisor is too rampantly pro-breast you can end up feeling you are being subjected to hard sell and people actually get turned off (this is not to criticise the rampantly pro-breast! I am fairly rampant myself )