Hi Andrew
Maternity services are underfunded and in many areas woefully inadequate. There are many decent, hardworking professionals in the service and it's often only their dedication that means things don't go wrong more often.
One of the enormous issues is breastfeeding support and the conflicting messages that women get whilst pregnant and as new mothers. Health professionals are often poorly trained, have no idea how to support a woman to start to breastfeed or what to do if she hits problems. All too often the "answer" is "here's a bottle".
And then there's guilt. I've written more about it here: www.howbreastfeedingworks.com/?p=58
I'd be interested to hear your thoughts on breastfeeding support. And not just "oh, yes, there should be some" but what you'd do to increase it. Do you, for instance, support the ban on ALL formula advertising, which would make it far easier for eg parenting magazines to run better articles because they're not worried about upsetting their advertisers? How about infant formula advertising to health professionals? Why is that still allowed?
Since nobody ever clicks links (), I've reproduced the guilt article here with, er, my permission:
"Breastfeeding Awareness Week, like a lot of the breastfeeding promotion stuff - I wonder whether it?s really only speaking to those who are likely to breastfeed anyway, come what may. Don?t get me wrong, I?m not knocking the excellent work done in raising awareness of the issues surrounding breastfeeding. For instance, campaigning for women to be able to breastfeed in public without people harassing them (and new legislation means this is the case, not just in Scotland but in England and Wales as well - at last!). The comments on that article show that this legislation is sadly needed. And there?s no doubt that more women are beginning to breastfeed now than ten years ago, than twenty years ago. But the length of time for which women breastfeed exclusively is still all too brief, so something?s going awry between initiation of breastfeeding and first and subsequent formula feeds that needs to be addressed.
We could perhaps begin do this is if we were to move away from talking about the benefits of breastfeeding and start talking about breastfeeding as the default option, the baseline. To do this, we would necessarily have to talk in terms of the ?risks? of formula feeding. This would be uncomfortable for many women with children of all ages who have had the ?choice? to formula feed thrust upon them by poor support from ill-informed and badly-trained healthcare professionals and also the general bottlefeeding culture we have in the UK - we don?t, as a rule, know how to support our friends and family to breastfeed.
One of the ways that formula manufacturers try to limit discussion of risk is by putting the ?don?t make women who can?t breastfeed feel guilty? message out there (it?s a key marketing strategy) and I promise, that?s the last thing I want to do. But I?d like to unpick that statement, if I may.
Why do women feel guilty about formula feeding?
One possible reason is that they wanted desperately to breastfeed, they bought into the list of ?benefits? wholeheartedly and they are aware that, whilst their child is likely to thrive on formula (in the West, anyway), it?s not what they wanted to do. It?s not how they envisaged being a mum. And the unspoken question is always if ?breast is best? then what is formula?
Another reason is that they don?t want to breastfeed at all, yet feel they ought to, or ought to want to. Some women in this situation might breastfeed for a time, but not really enjoy it and feeling burdened by something you are doing, or feel you should be doing is often a reason to feel guilty about it. This is especially the case when it comes to children - so much airtime is given to how we?re meant to raise children these days (from Annabel Karmel?s endless reams on ?how to make mashed potato interesting by putting faces on it with salad vegetables? to Supernanny?s insistence on ?unasseptable behav-yur?) that it?s impossible to have a baby and not know you?re ?meant? to want to breastfeed.
Can anything be done about this?
Well, the first group of women, those who wanted to breastfeed and were let down by those who ought to have been helping them - yes, a lot can be done there. Better-trained staff, a society that accepts breastfeeding, whether in a job centre, in family court, in McDonald?s or in an art gallery - all this would help to ensure a more conducive atmosphere for breastfeeding for any length of time. I believe that this would address to some extent the second group of women I mention - those who don?t really want to breastfeed. If it was the default option, more of them would feel comfortable giving it a try and if more women were breastfeeding in wider society, it might not be the isolating experience it can be now for some women.
What about the ?can?t??
This is something I often question when I am told ?don?t make women who can?t breastfeed feel guilty?. There are women who can?t breastfeed, of course there are. And of course I would hate to make them feel guilty. But this statement doesn?t mean them - or rather it doesn?t mean just them. It really means ?don?t say anything to make women who could actually have breastfed perfectly well, but were let down by those who were meant to be helping them feel guilty - because otherwise we might have to do something to improve support for them in the future and that?s bound to be expensive?. I?ve heard this exact statement from an MP, a local councillor and a GP in recent weeks in the context of ?it?s all well and good trying to improve breastfeeding support, but it makes women who can?t breastfeed feel guilty?. Depressing, eh? The very people who are placed to help - and they?re peddling the line that formula companies use to stifle debate about infant feeding.
So, shouldn?t we be aiming for a situation whereby every woman who wants to breastfeed and can physically do so (and some 98 or 99% of women fall into this category - and yes, I?m well aware that it?s not just physical ability that informs a woman?s feeding decision) actually does breastfeed for as long as she wants? What would we need in order for that to happen?
We?d need to stop talking about breastfeeding as a ?nice to have?, an ?optional extra?, something that ?adds benefit? - because if we keep referencing it in those terms, we necessarily set formula feeding as the baseline, the ?good enough?, the ?norm?. And we sweep any risks or detriments of formula feeding under the carpet, in case we make anyone feel bad.
But I wonder whether, for long-term gain, we need to start thinking in ways that are likely to cause discomfort for some women - by starting to talk more openly about the risks of formula feeding. Only then will society begin to see that breastfeeding shouldn?t be seen as something you do for a bit, if you must, something that isn?t very important, because formula is the same as breastmilk - or very nearly. Isn?t it?
Let?s see how we might talk about risk rather than benefit. Here?s a list of ?benefits? of breastfeeding - we can turn them very easily into a list of ?risks? of formula feeding - look:
Breastfeeding helps protect your baby against:
- ear infections
- gastro-intestinal infections
- chest infections
- urine infections
- childhood diabetes
- eczema
- obesity
- asthma.
Breastfeeding helps protect mothers against:
- ovarian cancer
- breast cancer
- weak bones later in life.
Women who breastfeed return to their pre-pregnancy figure faster.
Formula feeding increases the risk to your baby of:
- ear infections
- gastro-intestinal infections
- chest infections
- urine infections
- childhood diabetes
- eczema
- obesity
- asthma.
Formula feeding increases the risk to the mother of:
- ovarian cancer
- breast cancer
- weak bones later in life.
Women who formula feed return to their pre-pregnancy figure more slowly.
There are more risks listed here and numerous studies listed here
I appreciate that this is an uncomfortable way to talk about this and I am truly sorry if I?ve upset anybody. But I do think it?s necessary - or we run the risk of reaching a plateau with breastfeeding rates in this country - initiation will be OK, but numbers will still dwindle and women will still be being let down in the first six weeks. If breastfeeding isn?t viewed as important by those whose jobs it is to change things, if it?s deemed inappropriate to talk about the issues surrounding the risks of formula feeding for fear of upsetting those who have already been let down or made decisions based on half-truths and saccharine facts, nothing will change.
What do you think? Is it kinder not to talk about risks for fear of upsetting women who?ve already formula fed? Or is it doing a disservice to those women yet to have babies if we don?t talk about infant feeding in these terms? Is it, in fact, one of the biggest lies of early motherhood that it doesn?t matter how we feed our babies and women should concentrate on not feeling guilty or making other women feel guilty? Please don?t regale me with anecdotes of sickly breastfed babies you know and robust toddlers who?ve been formula fed. I appreciate that both of these exist, but it?s not helpful to get too involved with snapshots of children at a particular point in time.
Should we, in fact, have a Formula Feeding Awareness Week as well, where risks are discussed, rather than benefits? It would raise more eyebrows than Breastfeeding Awareness Week - but would it achieve anything except anger at ?breastfeeding mafia? types? Because if we look a bit more closely at the women who are supporting breastfeeding, for every one smug idiot type, there must be 100 who get on with it, quietly, intelligently and empathetically. And the smug idiot types do exist - and I loathe them, as much as you do, if not more - because they make my job considerably harder. Not only am I trying to compete with the £multimillion spend of the formula manufacturers, I have to also counter the idiotic statements made by boorish fools who think they?re supporting breastfeeding, but they?re in fact just trying to bolster their own self-esteem and mask their own failings by being smug about the one thing they?ve got right in their tiny lives."